Acute seizures predict epilepsy after childhood stroke

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.