Acute seizures predict epilepsy after childhood stroke

Abstract

Objective To determine incidence rates and predictors of epilepsy after childhood stroke and compare these to published estimates of 3–5% cumulative epilepsy incidence by five years post-stroke in adults. Methods In a retrospective population-based study of children with stroke (29 days−19 years) in an integrated health care system (1993–2007), post-stroke seizures were identified through electronic searches and confirmed by chart review. Stroke and seizure characteristics were abstracted from medical records. Survival analysis was used to determine rates and predictors of remote seizures and active epilepsy (anti-convulsant treatment for remote seizure within prior 6 months) at last follow-up. Results From a population of 2.5 million children, we identified 305 stroke cases. Over a median follow-up of 4.1 years (interquartile range 1.8–6.8), 49 children had a first unprovoked remote seizure. The average annual incidence rate of first remote seizure was 4.4% (95% confidence interval [CI] 3.3, 5.8) with a cumulative risk of 16% (CI 12%, 21%) at 5 years and 33% (CI 23%, 46%) at 10 years post-stroke. The cumulative risk of active epilepsy was 13% (CI 9%, 18%) at five years and 30% (CI 20%, 44%) at 10 years. Acute seizures at the time of stroke predicted development of active epilepsy (hazard ratio [HR] 4.2, CI 2.2, 8.1). At last follow-up, one-third of the children with active epilepsy had a recent breakthrough seizure despite anti-convulsant usage. Interpretation Unlike adults, children are uniquely vulnerable to epilepsy after stroke. Children with acute seizures at the time of stroke are at particularly high risk.

Heart Disease and Stroke Statistics—2015 Update

“…205 The cumulative risk of delayed seizures after later childhood stroke is 13% at 5 years and 30% at 10 years. 206 Children with acute seizures (within 7 days of their stroke) have the highest risk for delayed seizures, >70% by 5 years after the stroke.…”

Outcome in Childhood Stroke

“…23 Younger age, multifocal or cortical infarction, involvement of the middle cerebral artery territory, presence of focal cerebral arteriopathy, presence and duration of symptomatic seizures at the time of diagnosis are associated with increased risk of epilepsy. 24,25 Children with epilepsy complicating AIS have poorer cognitive outcomes 26 and quality of life 27 than those who do not.…”

Prevalence of Excess Sodium Intake in the United States — NHANES, 2009–2012

“…237 The cumulative risk of delayed seizures after later childhood stroke is 13% at 5 years and 30% at 10 years. 238 Children with acute seizures (within 7 days of their stroke) have the highest risk for delayed seizures, >70% by 5 years after the stroke. 239 …”