Pediatric epilepsy following neonatal seizures symptomatic of stroke

Suppiej, Agnese; Mastrangelo, Massimo; Mastella, Laura; Accorsi, Patrizia; Grazian, Luisa; Casara, Gianluca; Peruzzi, Cinzia; Carpanelli, Maria Luisa; Janes, Augusta; Traverso, Annalisa; Bernardina, Bernardo Dalla

doi:10.1016/j.braindev.2015.05.010

Cited by 35 publications

(20 citation statements)

References 27 publications

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“…Previous studies have shown that epilepsy develops in 21–67% of children with neonatal AIS, in 3% of children with neonatal AHS, in 17–41% of children with neonatal CSVT, in 13–41% of children with presumed AIS, and in 23% of children with presumed PVI . Some studies have not found any predictive factors for epilepsy after perinatal stroke, but others have shown that cortical lesions, large stroke size, involvement of the right middle cerebral artery or multiple territories, and neonatal seizures may predict remote seizures.…”

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confidence: 99%

Epilepsy after perinatal stroke with different vascular subtypes

et al. 2018

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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.

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confidence: 99%

Epilepsy after perinatal stroke with different vascular subtypes

et al. 2018

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“…In 54 children (62%), a physician diagnosis of cerebral palsy was recorded in the medical record. Children who presented with stroke during the neonatal period were more likely to have multiple infarcts (29% vs 3%, p 5 0.001), were younger when they began walking (median age of 13 [IQR 10-17] vs 16 [IQR [13][14][15][16][17][18][19][20][21][22] months, p 5 0.04), and were less likely to have a cerebral palsy diagnosis recorded (50% vs 85%, p 5 0.001) (table e-2). Otherwise, demographics, birth history, and years of follow-up were similar between the 2 groups.…”

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confidence: 99%

Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke

et al. 2016

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Objectives: To determine incidence rates and risk factors of remote seizure after perinatal arterial ischemic stroke. Methods:We retrospectively identified a population-based cohort of children with perinatal arterial ischemic stroke (presenting acutely or in a delayed fashion) from a large Northern Californian integrated health care system. We determined incidence and predictors of a remote seizure (unprovoked seizure after neonatal period, defined as 28 days of life) by survival analyses, and measured epilepsy severity in those with active epilepsy ($1 remote seizure and maintenance anticonvulsant treatment) at last follow-up.Results: Among 87 children with perinatal stroke, 40 (46%) had a seizure in the neonatal period.During a median follow-up of 7.1 years (interquartile range 3.2-10.5), 37 children had $1 remote seizure. Remote seizure risk was highest during the first year of life, with a 20% (95% confidence interval [CI] 13%-30%) cumulative incidence by 1 year of age, 46% (CI 35%-58%) by 5 years, and 54% (CI 41%-67%) by 10 years. Neonatal seizures increased the risk of a remote seizure (hazard ratio 2.8, CI 1.3-5.8). Children with neonatal seizures had a 69% (CI 48%-87%) cumulative incidence of remote seizure by age 10 years. Among the 24 children with active epilepsy at last follow-up, 8 (33%) were having monthly seizures despite an anticonvulsant and 7 (29%) were on more than one anticonvulsant.Conclusions: Remote seizures and epilepsy, including medically refractory epilepsy, are common after perinatal stroke. Neonatal seizures are associated with nearly 3-fold increased remote seizure risk. Neurology ® 2016;86:2179-2186 GLOSSARY AIS 5 arterial ischemic stroke; CI 5 confidence interval; HR 5 hazard ratio; ICD-9 5 International Classification of Diseases-9; IQR 5 interquartile range; KPNC 5 Kaiser Permanente Northern California; PPIS 5 presumed perinatal ischemic stroke.Perinatal arterial ischemic stroke (AIS) occurs in 1 in 4,000 term births and is an important cause of childhood epilepsy.1 In some newborns, an ischemic brain injury is initially unrecognized and only diagnosed later during development when a hemiparesis becomes clinically apparent or a remote symptomatic seizure occurs. This subset often receives a diagnosis of presumed perinatal ischemic stroke (PPIS), which refers to a stroke presumed to have occurred in the perinatal period because of a chronic focal infarction on neuroimaging.2 Stroke that is clinically apparent in the neonatal period may differ from PPIS. Seizures during the neonatal period are perhaps the most notable factor differentiating these groups, and are reported in about 75%-90% of infants diagnosed with stroke during the perinatal period.3-5 Neonatal seizures of any cause may confer a long-term risk of postnatal epilepsy. An estimated 10%-20% of neonates with seizures from any cause will go on to have further seizures in childhood. 6 Our objective was to measure the incidence rate and risk factors for a first remote seizure after perinatal AIS utilizing a previo...

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“…1,19 Os casos isolados de lesão na circulação posterior são raros. 19 A terapêutica com anticonvulsivantes é recomendada para todos os RN que apresentem convulsões, 5,14 sendo o fármaco de eleição o fenobarbital, 14,29 anticonvulsivante também utilizado na maioria dos casos do presente estudo. De referir que a literatura defende que este fármaco seja retirado precocemente durante os primeiros meses de vida, pelos efeitos secundários, nomeadamente cognitivos, que apresenta sobre um cérebro imaturo.…”

Section: Neuroimagemunclassified

“…De referir que a literatura defende que este fármaco seja retirado precocemente durante os primeiros meses de vida, pelos efeitos secundários, nomeadamente cognitivos, que apresenta sobre um cérebro imaturo. 4,29 De acordo com as orientações da American Heart Association e CHEST, a utilização de anticoagulantes após o diagnóstico de AVC neonatal está apenas recomendada para RN com evento cardioembólico documentado ou com deficiência de proteína C em homozigotia. 30,31 Desde modo, nenhum dos casos da presente amostra foi medicado com anticoagulantes.…”

Section: Neuroimagemunclassified

“…Na literatura descreve-se uma idade média de início de crises convulsivas de 4 anos e 2 meses, havendo referência a um risco superior de epilepsia se houver envolvimento da ACM direita. 29 O défice cognitivo grave, não avaliado isoladamente no presente estudo, é descrito na literatura em 8%-10% dos casos, 16,19 tendo sido verificado atraso global de desenvolvimento (que inclui défice cognitivo) em 27% da presente amostra. Um estudo recente indica que, quando comparadas com controlos emparelhados, as crianças com antecedentes pessoais de AVC neonatal têm um quociente de inteligência diminuído, indicando uma provável diminuição do potencial cognitivo.…”

Section: Neuroimagemunclassified

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AVC neonatal isquémico no registo nacional da Unidade de Vigilância Pediátrica - Como estão estas crianças 6 anos depois?

Fraga

Monteiro

2018

Acta Pediátrica Port

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Introduction: The study aims to analyse a cohort of newborns with symptomatic neonatal ischaemic stroke, including follow-up up to age 5-7 years. Methods: All newborns with symptomatic neonatal ischaemic stroke confirmed by brain magnetic resonance imaging were included in a prospective and descriptive cohort study, based on data from the national registry of paediatric stroke, between 2009-2011. Results: We analysed 21 newborns, 12 male, median gestational age 39 weeks and median birth weight 3389 g. Eighteen newborns had a significant obstetric or perinatal history: neonatal resuscitation (n=9), hypoxic ischaemic encephalopathy (n=2), traumatic delivery (n=1), early sepsis (n=2), congenital heart disease (n=1), and potential prothrombotic risk factors (n=8). All cases presented seizures between 6-72 hours of life (focal in 18), associated with hypotonia (n=11), apnoea (n=5) and feeding problems (n=4). The diagnosis was made by brain magnetic resonance, and magnetic resonance angiography was performed in three newborns. The left hemisphere was most often affected (n=13). Follow-up data at 2-3 years was obtained in 18 children: 10 had Introdução: Pretendeu-se avaliar uma coorte de recém-nascidos com acidente vascular cerebral isquémico neonatal sintomático, incluindo o seguimento até aos 5-7 anos. Métodos: Estudo de coorte prospetivo e descritivo, baseado em dados retirados do registo nacional de acidente vascular cerebral neonatal, entre 2009-2011. Foram incluídos os casos de acidente vascular cerebral isquémico neonatal sintomático confirmados por ressonância magnética crânio-encefálica. Resultados: Analisaram-se 21 recém-nascidos, 12 do sexo masculino, mediana da idade gestacional 39 semanas e do peso ao nascer 3389 g. Apresentaram antecedentes obstétricos ou perinatais significativos 18 recém-nascidos, salientando-se reanimação neonatal (n = 9), encefalopatia hipóxico-isquémica (n = 2), parto traumático (n = 1), sépsis precoce (n = 2), cardiopatia congénita (n = 4) e potenciais fatores de risco protrombóticos (n = 8). Todos apresentaram convulsões entre as 6-72 horas de vida (focais em 18), associando-se hipotonia (n = 11), apneia (n = 5) e dificuldade alimentar (n = 4). O diagnóstico foi confirmado por ressonância magnética crânio-encefálica, sendo realizada angiografia por ressonância magnética em três recém-nascidos. O hemisfério esquerdo foi o mais afetado (n = 13). Foi possível obter dados de seguimento aos 2-3 anos em 18 crianças: 10 tinham défice motor, quatro atraso global de desenvolvimento, duas epilepsia e oito sem sequelas. Dos 11 casos com seguimento mais longo (5-7 anos), sete apresentaram défice motor, três atraso global do desenvolvimento e perturbações da linguagem, uma epilepsia e quatro sem sequelas. Discussão: O seguimento longitudinal das crianças com acidente vascular cerebral neonatal é fundamental, uma vez que as sequelas se tornam evidentes a médio / longo prazo. Apesar da existência de fatores de risco significativos nos recém-nascidos com acidente vascular cerebral, a determinação d...

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Pediatric epilepsy following neonatal seizures symptomatic of stroke

Cited by 35 publications

References 27 publications

Epilepsy after perinatal stroke with different vascular subtypes

Epilepsy after perinatal stroke with different vascular subtypes

Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke

AVC neonatal isquémico no registo nacional da Unidade de Vigilância Pediátrica - Como estão estas crianças 6 anos depois?

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