Incidence and predictors of epilepsy after pediatric arterial ischemic stroke.
Publication/Presentation Date
2-14-2017
Abstract
OBJECTIVE: To determine the cumulative incidence and clinical predictors of remote symptomatic seizures and epilepsy after pediatric arterial ischemic stroke (AIS).
METHODS: We performed a retrospective analysis of 218 participants with neonatal AIS (NAIS), presumed perinatal AIS (PPAIS), and childhood AIS (CAIS) from a single-center prospective consecutive cohort enrolled from 2006 to 2014. Medical records were reviewed for timing, semiology, and treatment of acute symptomatic seizures, remote symptomatic seizures (RSS), and epilepsy. Cumulative incidence of RSS and epilepsy were assessed using survival analysis.
RESULTS: Acute symptomatic seizures occurred in 94% of NAIS (n = 70/74) and 17% of CAIS (n = 18/105). Younger children were more likely to present with seizures at stroke ictus, and acute symptomatic seizures were predictive of later RSS and epilepsy in CAIS. Median follow-up for the entire cohort was 34 months, interquartile range 44.9 months (16.3-61.2). Estimated cumulative incidence of RSS at 2 years was 19% in NAIS, 24% in PPAIS, and 7% in CAIS. Estimated cumulative incidence of epilepsy at 2 years was 11% in NAIS, 19% in PPAIS, and 7% in CAIS. The median time to these outcomes was < 2 years in all stroke subtypes. Among participants developing epilepsy (n = 34), seizures were often well-controlled at last follow-up with median Engel class of ≤2 (< 1 seizure/month).
CONCLUSIONS: RSS and epilepsy are important neurologic sequelae of pediatric AIS. Children with perinatal stroke and CAIS with acute symptomatic seizures are at increased risk of these outcomes. These cohorts need further study to identify biomarkers and potential therapeutic targets for epileptogenesis.
Volume
88
Issue
7
First Page
630
Last Page
637
ISSN
1526-632X
Published In/Presented At
Billinghurst, L. L., Beslow, L. A., Abend, N. S., Uohara, M., Jastrzab, L., Licht, D. J., & Ichord, R. N. (2017). Incidence and predictors of epilepsy after pediatric arterial ischemic stroke. Neurology, 88(7), 630–637. https://doi.org/10.1212/WNL.0000000000003603
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
28087825
Department(s)
Department of Pediatrics
Document Type
Article