Doença cerebrovascular na infância: I. Manifestações epilépticas

Abstract

RESUMO -As crises epilépticas podem constituir complicação de doença cerebrovascular (DCV), e a sua prevalência, apresentação clínica, fatores de risco e evolução em crianças tem sido estudadas por poucos autores. Neste estudo, 39 crianças com diagnóstico de DCV foram avaliadas quanto à ocorrência de manifestações epilépticas. Vinte e quatro (61,5%) apresentaram crises durante algum momento da doença (22 na fase aguda e 2 na tardia); 13 (54,2%) apresentaram crises generalizadas, 7 (29,2%) parciais, e 4 (16,6%) secundariamente generalizadas. A prevalência de manifestação epiléptica em lactentes foi significativamente maior (p=0,0362) do que nas outras faixas etárias. A localização cortical da DCV mostrou determinar de modo estatisticamente significante (p=0,0101) a ocorrência de crises. Não houve relação significativa entre o tipo de insulto vascular (isquêmico ou hemorrágico) e a ocorrência de crises. Quatorze pacientes evoluíram sem crise após a fase aguda; os 2 pacientes previamente epilépticos tiveram suas crises controladas com droga anti-epiléptica (DAE); 3 evoluíram com epilepsia (1 controlado com DAE e 2 de difícil controle); 3 continuaram em acompanhamento ambulatorial e não houve tempo hábil para definir se o quadro evoluirá para epilepsia e em 2 ocorreu óbito na fase aguda. PALAVRAS-CHAVE: epilepsia, doença cerebrovascular aguda, infância. Cerebrovascular disease in children: I. Epileptic manifestationsABSTRACT -Seizures may occur as a complication of cerebrovascular disease (CVD) and its prevalence, clinical presentation, risk factors and evolution have been reported by few authors. We evaluated 39 children with CVD and analysed the association with seizures. Seizures occurred in 24 (61.5%) patients and were classified as partial (29.2%), generalized (54.2%) and secondarily generalized (16.6%). Infants had a significantly higher prevalence of seizures (p=0.0362) than children at other ages. Cortical localization was associated with a significantly higher prevalence of seizures (p=0.0101). There were no differences between ischemic and hemorrhagic strokes. Fourteen patients had no seizures after the acute phase of the CVD, the 2 previously epileptic patients had their seizures controled with antiepileptic drugs, 3 developed epilepsy, 2 died during the acute phase and in 3 patients there was not enough time yet to make a clear diagnosis of epilepsy.

Cerebrovascular disease in pediatric patients

“…Our clinical findings for newborns are also in agreement with data in the literature 9,22,23 : most cases of stroke occur in term babies with a high Apgar score, who have seizures 24-48 hours after birth; and these patients respond better to the use of anticonvulsants. Our findings stress the importance of considering the hypothesis of stroke in newborns with seizures, even in the absence of hypoxic events.…”

“…Cortical atrophy was found in 2 patients, exactly those who presented with cognitive impairment at outpatient follow-up. EEG changes were in agreement with radiological findings, as reported in literature 19,22,23 .…”

Predictors of Epilepsy in Children With Cerebrovascular Disease

“…In a population-based study, more than half of children with stroke had epileptic seizures as the presenting symptom. 15 The few studies that have assessed the epileptic manifestations of cerebrovascular disease in children reported a 22% to 58% rate of early post-stroke epileptic seizures, [16][17][18][19][20][21] with seizures occurring up to 18 times more frequently than in adults 16 within 24 hours of stroke onset.…”

Atención al accidente cerebro vascular infantil: perspectiva de la neurología pediátrica

“…Según lo citado en la entrevista y en la literatura, existe la posibilidad de que algunos niños hayan sido atendidos varias horas después de la instalación de la agresión, puesto que los signos y síntomas iniciales no fueron recuperados hasta el momento de los síntomas epilépticos y trastornos motores. 5,6 La demora en la autorización para realizar las pruebas costosas como la tomografía computarizada y la resonancia magnética es otro error identificado en la red pública. Hay una gran demanda de estas pruebas porque no es sólo el derrame cerebral el que necesita de los mismos para un diagnóstico concluyente, junto con esto, no están todos los establecimientos de salud que realizan los exámenes de alto costo por el SUS.…”