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Outcomes of children with infantile spasms after perinatal stroke
Meredith R Golomb1, Bhuwan P Garg, Linda S Williams
1Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis 46202, USA. mgolomb@iupui.edu
Insights
Infantile spasms from perinatal stroke cause significant disability, including epilepsy and cerebral palsy. A small group with delayed diagnosis showed better outcomes, suggesting potential for improved management.
Area of Science:
- Neurology
- Pediatrics
- Developmental Neuroscience
Background:
- Infantile spasms are a severe epilepsy syndrome in infants.
- Perinatal stroke is a known cause of neurological impairment.
- Outcomes for infants with spasms secondary to perinatal stroke require further characterization.
Purpose of the Study:
- To describe the long-term outcomes of children experiencing infantile spasms caused by perinatal stroke.
- To identify risk factors and prognostic indicators within this specific patient cohort.
Main Methods:
- Retrospective review of hospital billing records using ICD-9 codes to identify patients with infantile spasms.
- Cross-referencing with pediatric stroke clinic records for comprehensive case identification.
- Analysis of clinical presentation, diagnostic timing, and long-term neurological and developmental outcomes.
Main Results:
- Perinatal stroke accounted for 5% of symptomatic infantile spasms.
- All identified children (100%) developed cerebral palsy, 90% had epilepsy, and 80% exhibited cognitive impairment.
- Children with delayed diagnosis of presumed perinatal stroke showed significantly better epilepsy and cognitive outcomes compared to those with neonatal presentation (P=0.03).
Conclusions:
- Perinatal stroke is an important etiology of infantile spasms, leading to substantial chronic disability.
- A subset of children with presumed perinatal stroke presenting later may have a more favorable prognosis regarding epilepsy and cognitive development.
- Early identification and intervention strategies for perinatal stroke-related infantile spasms warrant further investigation.
Abstract:
The object of this study was to describe the outcomes of children with infantile spasms resulting from perinatal stroke. We used International Classification of Diseases, Ninth Revision (ICD-9) searches of billing records to identify 110 children with infantile spasms examined at our hospital from 1998 through 2005. Five of the 99 with symptomatic spasms (5%) had perinatal stroke. An additional five children with spasms caused by perinatal stroke were identified from pediatric stroke clinic records. Seven of the 10 children with spasms due to perinatal stroke presented with stroke as neonates. Three initially appeared healthy but were diagnosed with "presumed perinatal stroke" after radiographic imaging for their spasms evaluation. Median age at last follow-up was 6.3 years: 9 (90%) had epilepsy, 8 (80%) manifested cognitive impairment, and all (100%) had cerebral palsy. The three children who had delayed presentation of "presumed perinatal stroke" had better epilepsy and cognitive outcomes than the seven with neonatal presentation (P = 0.03). Perinatal stroke accounts for 5% of symptomatic spasms and results in high rates of chronic disability similar to those observed with other types of symptomatic spasms. However, a subgroup of children with spasms caused by delayed presentation of "presumed perinatal stroke" appears to have better epilepsy and cognitive outcomes.
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