Association of Cerebral Palsy With Other Disabilities in Children With Perinatal Arterial Ischemic Stroke

Golomb, Meredith R.; Saha, Chandan; Garg, Bhuwan P.; Azzouz, Faouzi; Williams, Linda S.

doi:10.1016/j.pediatrneurol.2007.06.003

Cited by 35 publications

(32 citation statements)

References 8 publications

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“…Other studies found CP in 26% to 68%. 5,6,32,33 Different motor outcomes between studies can be explained by differences in functional measures, follow-up duration (patients with milder motor impairment might been missed), and methodological aspects (studies including only NAIS show motor problems less often than studies including PPIS because, by definition, this group frequently presents with motor problems). About one-third of patients showed delayed mental performance at the 2-year follow-up, in accordance with previous research, 34 but this proportion should not be overestimated.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke

et al. 2015

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BACKGROUND AND OBJECTIVES: Neonatal arterial ischemic stroke (NAIS) is associated with considerable lifetime burdens such as cerebral palsy, epilepsy, and cognitive impairment. Prospective epidemiologic studies that include outcome assessments are scarce. This study aimed to provide information on the epidemiology, clinical manifestations, infarct characteristics, associated clinical variables, treatment strategies, and outcomes of NAIS in a prospective, population-based cohort of Swiss children. RESULTS: One hundred neonates (67 boys) had a diagnosis of NAIS. The NAIS incidence in Switzerland during this time was 13 (95% confidence interval [CI], 11-17) per 100 000 live births. Seizures were the most common symptom (95%). Eighty-one percent had unilateral (80% left-sided) and 19% had bilateral lesions. Risk factors included maternal risk conditions (32%), birth complications (68%), and neonatal comorbidities (54%). Antithrombotic and antiplatelet therapy use was low (17%). No serious side effects were reported. Two years after birth, 39% were diagnosed with cerebral palsy and 31% had delayed mental performance.CONCLUSIONS: NAIS in Switzerland shows a similar incidence as other population-based studies. About one-third of patients developed cerebral palsy or showed delayed mental performance 2 years after birth, and children with normal mental performance may still develop deficits later in life. WHAT'S KNOWN ON THIS SUBJECT:Neonatal arterial ischemic stroke is associated with later cerebral palsy and cognitive impairment. Many studies on neonatal ischemic stroke are limited by modest sample sizes, and prospective studies that include outcomes assessments are scarce. WHAT THIS STUDY ADDS:Results from this prospective, nationwide, population-based study provide information on the epidemiology, associated clinical variables, clinical manifestation, vascular distribution, and treatment of neonatal arterial ischemic stroke. The study also provides outcomes regarding motor function and cognition.

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Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke

et al. 2015

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“…In that study, 42% of children did not have a diagnosis of CP and 19% had no neurological diagnosis. Because the Victorian Cerebral Palsy Register requires confirmation of the diagnosis of CP at 5 years of age, our study would have excluded children with subtle or no hemiplegia, and these children are thought to be at lower risk of epilepsy 15 . Furthermore, it is very likely that the longer follow‐up in our study allowed the detection of a greater proportion of incident cases of epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Epilepsy in hemiplegic cerebral palsy due to perinatal arterial ischaemic stroke

Wanigasinghe

Reid

Mackay

et al. 2010

Develop Med Child Neuro

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AIM The aim of this study was to describe the frequency, risk factors, manifestations, and outcome of epilepsy in children with hemiplegic cerebral palsy (CP) due to perinatal arterial ischaemic stroke (AIS). METHODThe study group comprised 63 participants (41 males, 22 females) from a populationbased CP register whose brain imaging showed perinatal AIS. Information collected included occurrence of neonatal seizures, family history of epilepsy, motor function and epilepsy onset, treatment, and outcome. Electroclinical findings were classified according to seizure semiology, seizure type, and epilepsy syndrome.RESULTS Mean age of participants at the time of study was 10 years 6 months (SD 4y 7mo, range 4-20y). Gross Motor Function Classification System levels I and II were reported in 96% of participants, and Manual Ability Classification System levels I and II were reported in 79% of children. Thirty-four children (54%) developed epilepsy. Term delivery and more severe motor impairment were associated with epilepsy, but neonatal seizures and family history of epilepsy were not. Initial seizures were epileptic spasms, focal seizures, or myoclonic seizures. Focal seizure semiology suggested Rolandic or occipital seizure origin in the majority of children. Focal epileptic discharges in children with focal seizures had features of idiopathic partial epilepsy. Only 15% of children had active epilepsy 10 years after onset.INTERPRETATION Despite a high incidence of epilepsy in children with hemiplegic CP due to AIS, the prognosis for seizure remission is good. Many children have clinical features, electroencephalography findings, and remission typical of idiopathic partial epilepsy.Epilepsy is a significant comorbidity in children with cerebral palsy (CP), potentially affecting cognitive development, mobility, and the ability to live independently. Estimates of the frequency depend on the pathology, the type of motor impairment, or both.1,2 Most studies have included multiple CP subtypes with diverse or uncertain aetiologies, and none has included detailed epilepsy evaluations with epilepsy syndrome classification. Little is known about risk factors and long-term outcome for specific epilepsy syndromes in a particular CP subtype.This study aimed to describe the epileptology in a group of young people with a common pathology and aetiology, namely children with hemiplegic CP resulting from perinatal arterial ischaemic stroke (AIS). We looked at risk factors, frequency and types of seizures, epilepsy syndromes, evolution of the epilepsy, and quality of life.

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“…In our own cohort of term neonates with perinatal arterial ischemic stroke, among children who presented with stroke in the neonatal period, 54% had cerebral palsy and 22% had moderate-severe cognitive impairment [1]. Approximately 67% of this cohort had childhood epilepsy, though almost a third of those children were able to be weaned off medication during the period that we followed them [22].…”

Section: Discussionmentioning

confidence: 97%

“…Mild epilepsy was defined as less than or equal to one seizure per month while on medication, while moderate-severe epilepsy was defined as more than one seizure per month while on medication. These outcome definitions have been used in previously reported work [5].…”

Section: Methodsmentioning

confidence: 99%

“…Many outcome studies of perinatal stroke exclude premature children because these children often have additional neurological complications of prematurity such as intraventricular hemorrhage and periventricular leukomalacia, making it difficult to compare them with term children who have isolated, focal cerebral injury [1][2][3]. Premature infants are often medically fragile in the perinatal period and the months beyond, which limits cerebral imaging and contributes to the dearth of data on this subject.…”

Section: Introductionmentioning

confidence: 99%

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Very Early Arterial Ischemic Stroke in Premature Infants

Golomb

Garg

Edwards-Brown

et al. 2008

Pediatric Neurology

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There have been few descriptions of early stroke in the premature infant. We present 23 infants born between 23 and 35 weeks gestational ages with focal arterial ischemic stroke occurring before 44 weeks gestational age. Ten (43%) were male. Five children (22%) were half of a twin pair; no cotwin died. The most commonly affected territory was the middle cerebral artery territory. Three children with extreme prematurity (<=26 weeks) had cerebellar infarcts. Twelve children had unilateral or bilateral intraventricular hemorrhages, which were grade 3 or higher in 8. Twelve children had white matter injury (periventricular lukomalacia and/or hypoxic ischemic encephalopathy). Most children had multiple additional comorbidities, and median neonatal intensive care unit stay was 63 days (range 14-365). One child died in the neonatal intensive care unit. All 22 survivors were left with disabilities. Seventeen (77%) had cerebral palsy, 10 (45%) had epilepsy, and 17 (77%) had cognitive impairment. Arterial ischemic stroke appears to add to the neurological disabilities commonly associated with prematurity.

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Association of Cerebral Palsy With Other Disabilities in Children With Perinatal Arterial Ischemic Stroke

Cited by 35 publications

References 8 publications

Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke

Incidence and Outcomes of Symptomatic Neonatal Arterial Ischemic Stroke

Epilepsy in hemiplegic cerebral palsy due to perinatal arterial ischaemic stroke

Very Early Arterial Ischemic Stroke in Premature Infants

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