BENIGN FOCAL EPILEPTIFORM DISCHARGES IN CHILDREN AFTER SEVERE HEAD TRAUMA - PROGNOSTIC VALUE AND CLINICAL COURSE

Purpose: To assess the occurrence and prognosis of benign focal epilep tiform discharges (BFED) in EEG after severe head trauma (SHT) in chil dren. Methods: Between January 1987 and December 1994, 47 of 828 child ren with anamnestic SHT showed a single or dominant epileptic focus in EEG. Spike wave localization and morphology were either suggestive fo r BFED (group I, 21 children) or were suspected to be symptomatic (gro up II, 26 children). We analyzed the course of epilepsy and epileptic discharges in EEG, neuroradiologic findings, neurologic outcome, and s chool adjustment. Results: After SHT, spike waves appeared immediately (within 72 h) or delayed (maximum 7 years) and disappeared between ag es 3 and 14 years in 14 children of group I and between ages 8 and 23 years in 10 of group II. Children with persistent spike waves in group I were all younger than 14 years; in group II, seven were older than 15 years. Computed tomographic (CT) lesions, ipsilateral to the epilep tic focus, were seen in 10 children of group I and 15 of group II. Ear ly seizures occurred in nine children of group I and eight of group II and late-onset seizures in one of group I and nine of group II (p = 0 .028). Epilepsy developed in three children of group I and 12 of group II and was drug refractory in six children of group II, all with pers istent epileptic foci. Regular schools were attended by 14 (67%) child ren in group I and 12 (48%) of group II. Conclusions: Benign focal epi leptiform discharges in posttraumatic EEGs have the same favorable pro gnosis as in benign focal epilepsy and should be handled as recommende d for classic benign focal epilepsy.