Epileptic Child Suffers Persistent Seizures After Fall at School

This case involves an 8-year-old boy with a history of idiopathic epilepsy who slipped and fell down the stairs at his school. The boy fell down 11 steps and hit his head on the way down. Prior to the accident, the boy’s epilepsy was well controlled with anti-epileptic medication. Following the incident, the boy complained of a persistent headache and neck pain. He was taken to a hospital where a CT and MRI were performed. Both scans returned negative. In the months following the accident, the patient’s seizure semiology changed and the frequency of his seizures increased dramatically. An expert pediatric neurologist was sought to opine on how a child with idiopathic epilepsy can still develop post-traumatic epilepsy following head trauma.

Question(s) For Expert Witness

1. Please describe your experience treating children with idiopathic epilepsy and/or post-traumatic epilepsy?

2. Can a patient with idiopathic epilepsy go on to develop post-traumatic epilepsy following head trauma?

3. What are the criteria for diagnosing post-traumatic epilepsy?

Expert Witness Response E-120510

I am the division director of child neurology a large west coast medical center. I follow about 1,000 children and adolescents with various forms of epilepsy, including about 15-20% with idiopathic epilepsy and about 5-6% with post-traumatic epilepsy. Yes, depending on the severity of the head trauma, it is possible for a child with idiopathic epilepsy to develop post-traumatic epilepsy following head trauma. However, sometimes trauma can also exacerbate pre-existing epilepsy without causing a new nidus of seizure-onset. But in this case, it's stated that the child's seizure semiology and EEG both changed, which implies more a new nidus of seizures, unmasking of a pre-existing nidus of seizures, or possibly non-epileptic/psychogenic spells. According to the Epilepsy Foundation, "Post-traumatic epilepsy (PTE) is by definition from a focal (localized) injury, and the frontal and temporal lobes are the most frequently affected regions. The likelihood of developing (post-traumatic) epilepsy after a TBI is higher with greater severity of the trauma, for example penetrating head injuries, when there is intracranial hematomas (bleeding), depressed skull fractures, a coma lasting more than 24 hours, and early seizures. As is true for non-traumatic epilepsy, imaging (MRI) often fails to show the cause, and, in that situation, it can be difficult to establish that epilepsy is post-traumatic." In general, post-traumatic epilepsy is diagnosed when unprovoked seizures arise de novo at least 1 week after head trauma, due to visible or microscopic brain injury sustained due to the incident head trauma.