Epilepsy after perinatal stroke with different vascular subtypes

Abstract

SummaryObjectiveWith an incidence up to 63 per 100,000 live births, perinatal stroke is an important cause of childhood epilepsy. The aim of the study was to find the prevalence of and predictive factors for epilepsy, and to describe the course of epilepsy in children with perinatal stroke with different vascular subtypes.MethodsPatients were retrieved from the Estonian Paediatric Stroke Database with follow‐up time at least 24 months. Patients were divided into 5 perinatal stroke syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction.ResultsThe final study group included 73 children with perinatal stroke (39 boys). With a median follow‐up time of 8.6 years, epilepsy was diagnosed in 21/73 (29%) children, most of whom had AIS (17/21, 81%). The 18‐year cumulative poststroke epilepsy risk according to the Kaplan‐Meier estimator was 40.8% (95% confidence interval [CI] 20.7–55.9%). The median age at epilepsy diagnosis was 50 months (range 1 month to 18.4 years). Children with neonatal AIS had the highest risk of epilepsy, but children with presumed AIS more often had severe epilepsy syndromes. Cortical lesions (odds ratio [OR] 19.7, 95% CI 2.9–133), and involvement of thalamus (OR 9.8, 95% CI 1.8–53.5) and temporal lobe (OR 8.3, 95% CI 1.8–39.6) were independently associated with poststroke epilepsy.SignificanceThe risk for poststroke epilepsy after perinatal stroke depends on the vascular subtype. Patients with perinatal AIS need close follow‐up to detect epilepsy and start with antiepileptic treatment on time.

Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta‐analysis

“…Early cerebral injury affects numerous cortical circuits such as the corticothalamic connections 109 and this may contribute to the pathogenesis of seizures for the approximately 25% of fetuses with PVHI who went on to develop seizures or epileptic encephalopathies. In children presenting with PVI outside the perinatal period, seizures were the presenting complaint in 6% to 17%, consistent with our findings 97,119 . The epilepsy rate of 25% is also comparable to common varieties of perinatal stroke in term‐born children 119 where it has been associated with adverse neurodevelopmental outcomes, 120,121 suggesting this may be a modifiable determinant of outcome from fetal GMH‐IVH.…”

Epileptic Spasms Predict Poor Epilepsy Outcomes After Perinatal Stroke

“…Similarly, a recent study found a lower incidence of epilepsy in periventricular venous infarction than perinatal arterial stroke; however, the 2 cases of epilepsy associated with periventricular venous infarction in the report led to refractory epileptic encephalopathies. 12 The relative sparing of cortical gray matter in periventricular venous infarction is thought to underlie the lower rates of epilepsy and cognitive sequelae. 13 However, the extensive number of epileptic spasms etiologies suggests a pathologic network that can be influenced at multiple brain regions, including cortex, subcortical structures, and brain stem, and often involve multiregional abnormalities.…”

“…The impact of seizures after perinatal stroke on cognition is still unclear, though it is more significant that epilepsy correlates with cognitive impairment. 12 Epileptic spasms, particularly in symptomatic cases including perinatal strokes, often leads to poor developmental outcomes. 27 Further studies are necessary to not only elucidate the effect of epileptic spasms on cognitive outcome in this population but to also assess whether rapid and successful treatment alters this course.…”

“…5 These later-onset presentations, classified as presumed perinatal stroke, also develop epilepsy at high rates, and their insidious onset often results in delays in the diagnosis of seizures. 4,[7][8][9][10][11][12] Perinatal arterial stroke often involves prominent cortical injury, which correlates with rates of epilepsy and the development of cognitive and behavioral impairments. 13,14 As perinatal arterial stroke is readily identifiable on imaging and tends to affect the same vascular distribution, its sequelae have been well described.…”

“…5 Studies distinguishing these 2 entities show lower rates of epilepsy with periventricular venous infarction compared with perinatal arterial stroke. 12,13 Yet periventricular venous infarction is more likely than perinatal arterial stroke to have secondary hemorrhagic transformation due to venous congestion. 5 Among children who develop remote seizures following perinatal stroke, there is a dramatic variability in long-term seizure burden, with a majority who do not go on to develop childhood epilepsy or are well controlled on medication, whereas a minority progress to drug resistance and significant comorbidities.…”