Early seizures predict the development of epilepsy in children and adolescents with stroke

Celina v. Stülpnagel, Tom Pieper, Karen Lidzba, Hans Holthausen, Martin Staudt,  Gerhard Kluger.  Early seizures predict the development of epilepsy in children and adolescents with stroke.  European Journal of Paediatric Neurology.  In press.

Highlights

•Identification of risk factors for epilepsy (E) after post-neonatal pediatric stroke.

•Retrospective analysis of 93 children with post-neonatal non-traumatic stroke.

•Early seizures, young age, cortical involvement on MRI more frequently with E.

•Stepwise multiple regression analysis in 46/93 patients with complete datasets.

•Identification of only early seizures as significant risk factor.

Summary

Purpose

To identify risk factors for the development of epilepsy after pediatric stroke.

Methods

Retrospective analysis of hospital charts of 93 children and adolescents with post-neonatal non-traumatic stroke and a minimum follow-up of two years. Seizures during the first 48 hours after onset of stroke symptoms were defined as “early seizures”; when two or more seizures occurred after this period, the patient was classified as “epileptic”.

Results

Early seizures, young age at stroke and MRI evidence of cortical involvement were observed more frequently in the children who developed epilepsy. These factors were, however, significantly interrelated; a stepwise multiple regression analysis in 46/93 patients with complete datasets identified only the occurrence of early seizures as a significant risk factor: 15/19 (79%) children with early seizures developed epilepsy, as opposed to only 7/53 (13%) without early seizures.

Conclusion

Children with stroke who show seizures during the first 48 hours after onset of stroke symptoms have a high risk to develop post-stroke epilepsy, whereas in children without early seizures, post-stroke epilepsy is rare.