Investigators at Mattel Children's Hospital, UCLA, and University of Colorado, used continuous video-EEG monitoring (cEEG) to study the incidence and risk factors for subclinical early posttraumatic seizures (EPTS) in 87 consecutive, unselected (mild – severe), acute traumatic brain injury (TBI) patients requiring admission to the PICU. Thirty-seven (42.5%) had seizures: subclinical in 16.1% (only subclinical in 6.9%), status epilepticus (SE) in 18.4%, and subclinical SE in 13.8%. Risk factors for subclinical seizures and SE included younger age, abusive head trauma, and intraaxial bleed. SE and subclinical SE were associated with increased hospital length of stay. cEEG monitoring significantly improves detection of seizures and is the only way to detect subclinical seizures (SE). 
COMMENT. Continuous EEG monitoring is recommended in young children with TBI, particularly in those with abusive head trauma and in those with intraaxial blood on CT. Rapid detection and treatment of EPTS may be of benefit in the immediate management of patients with TBI, but control of subclinical EPTS may not prevent occurrence of late posttraumatic epilepsy nor reflect long-term adverse effects of AEDs on the developing brain.