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Dev Med Child Neurol. 2017 Jan;59(1):38-44. doi: 10.1111/dmcn.13198. Epub 2016 Jul 16.

Prolonged or recurrent acute seizures after pediatric arterial ischemic stroke are associated with increasing epilepsy risk.

Author information

1
Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
2
Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
3
Department of Neurology, Royal Children's Hospital, Melbourne, Vic., Australia.
4
Murdoch Children's Research Institute, Melbourne, Vic., Australia.
5
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
6
Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
7
Department of Neurology, Children's National Medical Center, Washington, DC, USA.
8
Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debrè Hospital, Paris, France.
9
Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

Abstract

AIM:

To determine epilepsy risk factors after pediatric stroke.

METHOD:

A cohort of children with arterial ischemic stroke (birth-18y) was enrolled at 21 centers and followed for 1 year. Acute seizures (≤7d after stroke) and active epilepsy (at least one unprovoked remote seizure plus maintenance anticonvulsant at 1y) were identified. Predictors were determined using logistic regression.

RESULTS:

Among 114 patients (28 neonates and 86 children) enrolled, 26 neonates (93%) and 32 children (37%) had an acute seizure. Acute seizures lasted longer than 5 minutes in 23 patients (40%) and were frequently recurrent: 33 (57%) had 2 to 10 seizures and 11 (19%) had more than 10. Among 109 patients with 1-year follow-up, 11 (10%) had active epilepsy. For each year younger, active epilepsy was 20% more likely (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-0.99, p=0.041). Prolonged or recurrent acute seizures also increased epilepsy risk. Each additional 10 minutes of the longest acute seizure increased epilepsy risk fivefold (OR 4.7, 95% CI 1.7-13). Patients with more than 10 acute seizures had a 30-fold increased epilepsy risk (OR 30, 95% CI 2.9-305).

INTERPRETATION:

Pediatric stroke survivors, especially younger children, have a high risk of epilepsy 1 year after stroke. Prolonged or recurrent acute seizures increase epilepsy risk in a dose-dependent manner.

Comment in

PMID:
27422813
DOI:
10.1111/dmcn.13198
[Indexed for MEDLINE]
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