Elsevier

The Journal of Pediatrics

Volume 151, Issue 4, October 2007, Pages 409-413.e2
The Journal of Pediatrics

Original article
Perinatal Stroke and the Risk of Developing Childhood Epilepsy

https://doi.org/10.1016/j.jpeds.2007.03.058Get rights and content

Objectives

To describe the prevalence of epilepsy after 6 months of age in children with perinatal stroke and examine whether perinatal data predict epilepsy onset and resolution.

Study design

A retrospective review of 64 children with perinatal stroke. In children with at least 6 months of follow-up data, Kaplan-Meier curves, univariate log-rank tests, and Cox proportional hazards models were used to examine predictors of time to development of seizures, and time to resolution of seizures in children with epilepsy. The association of risk factors with the presence of epilepsy at any time after 6 months of age was examined using Fisher’s exact test.

Results

Forty-one of the 61 children with at least 6 months of follow-up data (67%) had epilepsy between 6 months of age and last follow-up, but in 13 of 41, seizures eventually resolved and anticonvulsants were discontinued. Infarct on prenatal ultrasonography (P = .0065) and family history of epilepsy (P = .0093) were significantly associated with time to development of seizures after 6 months of age in the univariate analysis. No assessed variables were associated with time to resolution of epilepsy or with the presence of epilepsy after 6 months of age.

Conclusions

Childhood epilepsy is frequent after perinatal stroke. Evidence of infarction on prenatal ultrasonography and a family history of epilepsy predict earlier onset of active seizures.

Section snippets

Population

This study was conducted at the Riley Hospital for Children, Indianapolis, Indiana. Sixty-four children with perinatal arterial ischemic stroke were initially identified using a combination of the following techniques: review of neurology clinic records from January 1990 to January 2007; patient referral; and International Classification of Disease, 9th revision, clinical modification code searches from May 1, 1999 to May 1, 2004 using codes 767 (neonatal stroke), 433 (occlusion and

Patient Population

Sixty-four children with perinatal arterial ischemic stroke were identified. Thirty-six (56%) were male. Forty-eight (75%) presented in the NICU with seizures. All children with seizures were treated with phenobarbital. Additional medications used included lorazepam (8), phenytoin (8), diazepam (1), and fosphenytoin (1). Additional presentations that prompted neurological evaluation included apnea (19), respiratory distress (12), abnormal tone (11), poor feeding (9), poor respiratory effort

Discussion

Seizures are a frequent presenting sign of perinatal arterial ischemic stroke, and childhood epilepsy is a frequent resulting morbidity. In our cohort, 75% (48 of 64) of children with perinatal stroke presented with seizures, and 67 % (41 of 61 with ≥6 months of follow-up) had or developed epilepsy after 6 months of age. Epilepsy resolved in 13 children, so 46% (28 of 61) had epilepsy as of last follow-up. Sixty-four percent (18 of 28) of the children with epilepsy were eventually seizure-free

References (22)

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  • Cited by (0)

    1

    Dr Golomb is supported by the National Institutes of Health NINDS grant K23 NS048024 and the Clarian Values Fund grant VFR-171.

    2

    Dr Williams is supported by the National Institutes of Health NINDS R01 NS 39571 and a VA Health Services Research and Development Career Award.

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