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Published on: June 13, 2025
Epilepsy after perinatal stroke with different vascular subtypes
Rael Laugesaar1,2, Ulvi Vaher2, Silva Lõo1,3,4
1Department of Pediatrics Institute of Clinical Medicine University of Tartu Tartu Estonia.
Insights
Perinatal stroke is a significant cause of childhood epilepsy. Epilepsy risk varies by stroke type, with arterial ischemic stroke (AIS) posing the highest risk, necessitating close monitoring.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- Perinatal stroke is a leading cause of childhood epilepsy, affecting up to 63 per 100,000 live births.
- Understanding epilepsy prevalence and risk factors in perinatal stroke survivors is crucial for early intervention.
Purpose of the Study:
- To determine the prevalence and predictive factors of epilepsy in children with perinatal stroke.
- To describe the epilepsy course across different perinatal stroke vascular subtypes.
Main Methods:
- Retrospective analysis of the Estonian Paediatric Stroke Database with a minimum 24-month follow-up.
- Classification of perinatal stroke into five syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction.
Main Results:
- Epilepsy was diagnosed in 29% of 73 children with perinatal stroke over a median follow-up of 8.6 years.
- The 18-year cumulative epilepsy risk was 40.8%, highest in neonatal AIS.
- Cortical lesions, thalamus, and temporal lobe involvement were independently associated with poststroke epilepsy.
Conclusions:
- The risk of poststroke epilepsy is significantly influenced by the vascular subtype of perinatal stroke.
- Children with perinatal arterial ischemic stroke require vigilant follow-up for timely epilepsy detection and treatment.
Objective:
With an incidence up to 63 per 100,000 live births, perinatal stroke is an important cause of childhood epilepsy. The aim of the study was to find the prevalence of and predictive factors for epilepsy, and to describe the course of epilepsy in children with perinatal stroke with different vascular subtypes.
Methods:
Patients were retrieved from the Estonian Paediatric Stroke Database with follow-up time at least 24 months. Patients were divided into 5 perinatal stroke syndromes: neonatal arterial ischemic stroke (AIS), neonatal hemorrhagic stroke, neonatal cerebral sinovenous thrombosis, presumed AIS, and presumed periventricular venous infarction.
Results:
The final study group included 73 children with perinatal stroke (39 boys). With a median follow-up time of 8.6 years, epilepsy was diagnosed in 21/73 (29%) children, most of whom had AIS (17/21, 81%). The 18-year cumulative poststroke epilepsy risk according to the Kaplan-Meier estimator was 40.8% (95% confidence interval [CI] 20.7-55.9%). The median age at epilepsy diagnosis was 50 months (range 1 month to 18.4 years). Children with neonatal AIS had the highest risk of epilepsy, but children with presumed AIS more often had severe epilepsy syndromes. Cortical lesions (odds ratio [OR] 19.7, 95% CI 2.9-133), and involvement of thalamus (OR 9.8, 95% CI 1.8-53.5) and temporal lobe (OR 8.3, 95% CI 1.8-39.6) were independently associated with poststroke epilepsy.
Significance:
The risk for poststroke epilepsy after perinatal stroke depends on the vascular subtype. Patients with perinatal AIS need close follow-up to detect epilepsy and start with antiepileptic treatment on time.
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