European Journal of Cardiovascular Medicine

Posttraumatic seizures (PTS) are often divided (arbitrarily) into early (occurring within 1 week of injury) and late (thereafter) [1]. There may be justification for a third category: “immediate,” i.e., within minutes to an hour or so.

30% incidence in severe head injury (“severe” defined as: LOC > 24 hrs, amnesia > 24 hrs, focal neuro deficit, documented contusion, or intracranial hematoma) and ≈ 1% in mild to moderate injuries. Occurs in 2.6% of children < 15 yrs of age with head injury causing at least brief LOC or amnesia [2]. Early PTS may precipitate adverse events as a result of elevation of ICP, alterations in BP, changes in oxygenation, and excess neurotransmitter release [3].

Late onset PTS (< 7 days after head trauma) Estimated incidence 10–13% within 2 yrs after “significant” head trauma (includes LOC > 2 mins, GCS < 8 on admission, epidural hematoma…) for all age groups [4, 5]. Relative risk: 3.6 times control population. Incidence in severe head injury > moderate > mild [2]. The incidence of early PTS is higher in children than adults, but late seizures are much less frequent in children (in children who have PTS, 94.5% develop them within 24 hrs of the injury [6]. Most patients who have not had a seizure within 3 yrs. of penetrating head injury will not develop seizures [7]. Risk of late PTS in children does not appear related to the occurrence of early PTS (in adults: only true for mild injuries). Risk of developing late PTS may be higher after repeated head injuries. The incidence of PTS is higher with penetrating head injuries than with closed head injuries (occurs in 50% of penetrating trauma cases followed 15 yrs. [8].