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Published on: June 11, 2020
Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke
Christine K Fox1, Hannah C Glass2, Stephen Sidney2
1From the Departments of Neurology (C.K.F., H.C.G., H.J.F.), Pediatrics (C.K.F., H.C.G., H.J.F.), and Epidemiology and Biostatistics (H.C.G.), University of California, San Francisco; the Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; and the Division of Pediatric Neurology (S.E.S.), Kaiser Permanente Oakland Medical Center, CA. Christine.Fox@ucsf.edu.
Insights
Remote seizures and epilepsy are common in children following perinatal stroke. Neonatal seizures significantly increase the risk of later unprovoked seizures, highlighting the need for early intervention.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- Perinatal arterial ischemic stroke (PAIS) is a significant cause of neurological disability in children.
- Seizures are a common complication of PAIS, impacting long-term neurodevelopmental outcomes.
- Understanding the incidence and risk factors for remote seizures is crucial for effective management.
Purpose of the Study:
- To determine the incidence rates of remote seizures after PAIS.
- To identify risk factors associated with the development of remote seizures.
- To assess the severity of epilepsy in affected children.
Main Methods:
- Retrospective cohort study of children with PAIS in Northern California.
- Survival analyses were used to determine incidence and predictors of remote seizures.
- Epilepsy severity was measured in children with active epilepsy at last follow-up.
Main Results:
- Among 87 children with PAIS, 46% experienced neonatal seizures.
- The cumulative incidence of remote seizures by age 10 years was 54%.
- Neonatal seizures were associated with a 2.8-fold increased risk of remote seizures (69% cumulative incidence by age 10).
Conclusions:
- Remote seizures and epilepsy, including medically refractory epilepsy, are frequent after PAIS.
- Neonatal seizures are a significant predictor of increased remote seizure risk.
- Early identification and management of neonatal seizures may mitigate long-term epilepsy risk.
Objectives:
To determine incidence rates and risk factors of remote seizure after perinatal arterial ischemic stroke.
Methods:
We retrospectively identified a population-based cohort of children with perinatal arterial ischemic stroke (presenting acutely or in a delayed fashion) from a large Northern Californian integrated health care system. We determined incidence and predictors of a remote seizure (unprovoked seizure after neonatal period, defined as 28 days of life) by survival analyses, and measured epilepsy severity in those with active epilepsy (≥1 remote seizure and maintenance anticonvulsant treatment) at last follow-up.
Results:
Among 87 children with perinatal stroke, 40 (46%) had a seizure in the neonatal period. During a median follow-up of 7.1 years (interquartile range 3.2-10.5), 37 children had ≥1 remote seizure. Remote seizure risk was highest during the first year of life, with a 20% (95% confidence interval [CI] 13%-30%) cumulative incidence by 1 year of age, 46% (CI 35%-58%) by 5 years, and 54% (CI 41%-67%) by 10 years. Neonatal seizures increased the risk of a remote seizure (hazard ratio 2.8, CI 1.3-5.8). Children with neonatal seizures had a 69% (CI 48%-87%) cumulative incidence of remote seizure by age 10 years. Among the 24 children with active epilepsy at last follow-up, 8 (33%) were having monthly seizures despite an anticonvulsant and 7 (29%) were on more than one anticonvulsant.
Conclusions:
Remote seizures and epilepsy, including medically refractory epilepsy, are common after perinatal stroke. Neonatal seizures are associated with nearly 3-fold increased remote seizure risk.
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