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Acute seizures predict epilepsy after childhood stroke

Christine K Fox1, Hannah C Glass, Stephen Sidney

  • 1Departments of Neurology, University of California, San Francisco, San Francisco, CA.

Annals of Neurology
|April 25, 2013
PubMed

Insights

Childhood stroke significantly increases epilepsy risk, with a 16% cumulative incidence by 5 years. Acute seizures at stroke onset are a key predictor of developing active epilepsy in children.

Area of Science:

  • Neurology
  • Pediatric Stroke
  • Epilepsy Research

Background:

  • Childhood stroke is a significant concern with potential long-term neurological sequelae.
  • Epilepsy is a common complication following stroke, but incidence rates in children are not well-established.
  • Published estimates for adult post-stroke epilepsy range from 3-5% cumulative incidence by 5 years.

Purpose of the Study:

  • To determine the incidence rates of epilepsy following childhood stroke.
  • To identify predictors for developing epilepsy after a stroke in children.
  • To compare childhood post-stroke epilepsy rates with those observed in adults.

Main Methods:

  • Retrospective, population-based study of children (29 days-19 years) with stroke.
  • Identification of post-stroke seizures via electronic searches and chart review.
  • Survival analysis to determine rates and predictors of remote seizures and active epilepsy.

Main Results:

  • 305 childhood stroke cases identified from 2.5 million children.
  • Cumulative risk of active epilepsy reached 13% at 5 years and 30% at 10 years post-stroke.
  • Acute seizures at the time of stroke predicted active epilepsy development (HR=4.2).

Conclusions:

  • Children are uniquely vulnerable to epilepsy after stroke, with higher incidence than adults.
  • Children experiencing acute seizures during stroke are at a particularly elevated risk for epilepsy.
  • A significant proportion of children with active epilepsy experience breakthrough seizures despite treatment.
Abstract

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