Pediatric post-traumatic epilepsy: A retrospective analysis of frequency, risk factors and clinical outcomes following traumatic brain injury

Background and Objective: Post-traumatic epilepsy (PTE) is a substantial complication of pediatric traumatic brain injury (TBI) that has the potential to have long-term neurologic and functional consequences. However, local data are scarce on the frequency, indicators, and clinical outcomes of PTE in children in Pakistan. This study ascertained the incidence of PTE among children after TBI and assessed related clinical outcomes and predictors. Methodology: This retrospective cohort study included 254 children with TBI managed at the Department of Neurosurgery, Unit-II, Punjab Institute of Neurosciences Lahore, Pakistan. The study cohort comprised children who sustained TBI between May 2023 and May 2026. Demographics, injury characteristics, early post-traumatic seizures, radiological findings, and interventions were collected. PTE was defined as two or more unprovoked seizures occurring more than seven days after injury. Predictors were identified using bivariate and multivariable logistic regression analyses. Results: The proportion of children who developed PTE was 13.8% (35), 95% CI 10.1–18.6%. This proportion increased with TBI severity, reaching 24.1% (19) in severe cases. Early post-traumatic seizures were the strongest independent predictor of PTE (adjusted OR 2.81; 95% CI 1.18–6.69; p = 0.020). Status epilepticus, intraparenchymal hemorrhage, and midline shift were positively associated but not statistically significant after adjustment; given the model's limited events-per-variable ratio, these multivariable findings should be regarded as exploratory rather than confirmatory. Children with PTE demonstrated higher rates of neurological deficit, 68.6% (24) vs children without PTE, 23.3% (51), cognitive impairment, 65.7% (23) vs 18.7% (41), and motor disability 37.1% (13) vs 11.0% (24), respectively. Conclusion: PTE affects a significant proportion of children following TBI, particularly those with severe injuries and early post-traumatic seizures, and is associated with substantially higher rates of neurological, cognitive, and motor impairment. Given the limited events-per-variable ratio, treat the identified multivariable predictors as exploratory until validation in larger prospective cohorts.