1. Prolonged or recurrent acute seizures after pediatric arterial ischemic stroke are associated with increasing epilepsy risk
- Author
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Fox, Christine K, Mackay, Mark T, Dowling, Michael M, Pergami, Paola, Titomanlio, Luigi, Deveber, Gabrielle, and Investigators, the SIPS
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Neurosciences ,Brain Disorders ,Pediatric ,Neurodegenerative ,Clinical Research ,Stroke ,Epilepsy ,Management of diseases and conditions ,7.3 Management and decision making ,Adolescent ,Age Factors ,Brain Ischemia ,Child ,Child ,Preschool ,Female ,Follow-Up Studies ,Humans ,Infant ,Infant ,Newborn ,Male ,Online Systems ,Recurrence ,Risk Factors ,SIPS Investigators ,Medical and Health Sciences ,Pediatrics ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
AimTo determine epilepsy risk factors after pediatric stroke.MethodA 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.ResultsAmong 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).InterpretationPediatric 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.
- Published
- 2017