Evolution of epileptic encephalopathy in an infant with non-accidental head injury.

A 5-month-old child, previously healthy, was hospitalized with frequent episodes of tonic seizures. The seizures were controlled with antiepileptic medication. However, the parents did not continue medications after discharge from the hospital. The child was admitted several times with breakthrough seizures. Over time the seizures became refractory to treatment. Neurometabolic work up and imaging studies for uncontrolled seizures revealed non-accidental head injury (shaken baby syndrome) as the underlying cause. His first EEG was normal and changed from normal to an epileptic encephalopathy pattern during his several admissions for uncontrolled seizures. From a normal child at the first admission, the child was severely regressed at the last admission. The present paper highlights the evolution of EEG changes in a child with non-accidental head injuries. This report also highlights considering non-accidental head injury as the underlying cause in younger children presenting with unexplained epileptic encephalopathy.