Prolonged or recurrent acute seizures after pediatric arterial ischemic stroke are associated with increasing epilepsy risk

Abstract

AIM To determine epilepsy risk factors after pediatric stroke. METHOD A cohort of children with arterial ischemic stroke (birth-18y) was enrolled at 21 centers and followed for 1 year. Acute seizures (≤7d after stroke) and active epilepsy (at least one unprovoked remote seizure plus maintenance anticonvulsant at 1y) were identified. Predictors were determined using logistic regression.RESULTS Among 114 patients (28 neonates and 86 children) enrolled, 26 neonates (93%) and 32 children (37%) had an acute seizure. Acute seizures lasted longer than 5 minutes in 23 patients (40%) and were frequently recurrent: 33 (57%) had 2 to 10 seizures and 11 (19%) had more than 10. Among 109 patients with 1-year follow-up, 11 (10%) had active epilepsy. For each year younger, active epilepsy was 20% more likely (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-0.99, p=0.041). Prolonged or recurrent acute seizures also increased epilepsy risk. Each additional 10 minutes of the longest acute seizure increased epilepsy risk fivefold (OR 4.7, 95% CI 1.7-13). Patients with more than 10 acute seizures had a 30-fold increased epilepsy risk (OR 30, 95% CI 2.9-305).INTERPRETATION Pediatric stroke survivors, especially younger children, have a high risk of epilepsy 1 year after stroke. Prolonged or recurrent acute seizures increase epilepsy risk in a dose-dependent manner.Arterial ischemic stroke (AIS) is a leading cause of childhood brain injury. Many survivors suffer from permanent disability and epilepsy, although a subset recover without significant deficits. One of the critical differences of pediatric stroke compared with stroke in adults is that children frequently experience acute symptomatic seizures. Only 2% to 4% of adults with stroke have an acute seizure.1 In contrast, an estimated 75% to 90% of neonates and 20% to 30% of children with AIS have acute seizures.2-7 Convulsions at stroke presentation are more likely in young children. 8,9 Although determinants of epilepsy after pediatric AIS are poorly understood, emerging data suggest early seizures may be associated. 6,[10][11][12] Therefore, the high incidence of acute seizures after pediatric AIS is worrisome. However, we know little about the characteristics of children who have acute seizures, or the mechanisms by which acute seizures are associated with epilepsy.Large, prospective studies of neonates and children are critical to understand which patients are at greatest risk of epilepsy, and how acute seizures or other factors might influence that risk. Moreover, accurate prediction of epilepsy risk will allow providers to appropriately counsel patients and families and guide future research. We aimed to prospectively determine incidence rates and risk factors of acute seizures and epilepsy after pediatric AIS. We hypothesized that age at the time of a stroke is an important determinant both of acute symptomatic seizures and of later development of post-stroke epilepsy. Further, we hypothesized that the duration and frequency of acute seizures during the first week af...

Children with post-stroke epilepsy have poorer outcomes one year after stroke

“…Cohort characteristics (online Supplementary Table 1) were similar to the previously published SIPS cohort that included neonatal AIS. 5 Follow-up data were available for 80 children (4 deceased, 2 lost to follow-up) at a median of 12.1 months (interquartile range (IQR) = 11.4–12.9) post-stroke. At 1 year, 18/80 (23%) were taking a maintenance anticonvulsant including 8/80 (10%) who met our definition of epilepsy.…”

“…Seizures in Pediatric Stroke (SIPS) investigators enrolled children aged 29 days-19 years with acute AIS and identified seizures during the first year post-stroke as previously described. 5 At one year, neurologists examined children to score outcomes using the Pediatric Stroke Outcome Measure (PSOM). All sites obtained ethics approval from local institutional review boards.…”

Akut symptomatische Anfälle vs. beginnende Epilepsie nach Schlaganfall bei Erwachsenen und Kindern

“…Wenn man neonatale ASA (innerhalb der ersten 28 Lebenstage) hinzurechnet, liegen die Zahlen noch höher. Umso jünger die Patienten zum Zeitpunkt des Insultes sind und umso häufiger und länger die ASA dauern, desto größer scheint das Epilepsierisiko zu sein [13]. In einer retrospektiven populationsbasierten Studie in Kalifornien bei Kindern im Alter zwischen 29 Tagen und 19 Jahren (neonatale Anfälle waren ausgenommen) belief sich das kumulative Risiko für einen ersten unprovozierten Anfall (definiert als > 30 Tage nach dem Schlaganfall) auf 16 % innerhalb von 5 Jah-ren und 33 % innerhalb von 10 Jahren.…”

The Potential Role of MicroRNA-124 in Cerebral Ischemia Injury

“…Hyperexcitability and hypersynchrony of neuronal networks are the major pathogenies that contribute to the epileptic activity. A new theory has been put forward saying that genetic defects, as well as cerebral hypoperfusion are responsible for the negative consequences of epilepsy [132] One of the prominent pathological characteristics of ischemic stroke is reactive astrocytes, which then express higher glial fibrillary acidic protein and eventually trigger astroglial scar formation [133], which is the major effect on neuronal excitability [75,76]. Moreover, ischemia-induced BBB disruption, an anatomic alteration after cerebral ischemia [1], is also a fundamental catalyst for the initiation of epilepsy [134].…”

The design of a homocysteine fluorescent probe based on Rhodamine B and its responsiveness in the serum of cerebral infarction patients�

“…Clinical and epidemiological data have confirmed that homocysteine (Hcy) is an important risk factor for cardiovascular diseases and is closely associated with the pathogenesis of cerebral infarction (5). The level of Hcy in the plasma of patients with cerebral infarction is significantly higher compared with that of the healthy population (6,7). Therefore, efficient methods of monitoring Hcy levels provides a potentially useful avenue for the early diagnosis, prevention and treatment, as well as prognosis, of patients affected by cerebral infarction.…”