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Pediatric Cerebral Sinovenous Thrombosis and Risk for Epilepsy
Alexis R Karlin1, Nankee K Kumar2, Arastoo Vossough3
1Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Acute seizures in pediatric cerebral sinovenous thrombosis (CSVT) predict epilepsy in children. Both neonates and children with epilepsy after CSVT experienced worse outcomes.
Area of Science:
- Neurology
- Pediatric Stroke
- Epileptology
Background:
- Cerebral sinovenous thrombosis (CSVT) is a rare but serious condition in children, often leading to significant long-term health issues.
- Understanding the occurrence and predictors of seizures and subsequent epilepsy is crucial for managing pediatric CSVT.
Purpose of the Study:
- To determine the cumulative incidence of acute seizures, remote seizures, and epilepsy following pediatric CSVT.
- To identify predictors for these seizure outcomes and assess their impact on long-term neurological function.
Main Methods:
- A retrospective analysis of 131 neonates and children with neuroimaging-confirmed CSVT was conducted.
- Seizure types were categorized as acute (within 7 days) or remote (>7 days), and epilepsy was defined by recurrent remote seizures.
- Survival analysis methods were employed to determine incidence and risk factors.
Main Results:
- Acute seizures occurred in 42% of neonates and 19% of children. Hemorrhage was a predictor of acute seizures in children.
- Epilepsy developed in 5/6 neonates and 10/14 children who experienced remote seizures.
- One- and 3-year epilepsy-free survival rates were calculated, with worse Pediatric Stroke Outcome Measure scores observed in patients with epilepsy.
Conclusions:
- Acute seizures are a significant risk factor for epilepsy in children with CSVT.
- The presence of epilepsy in neonates and children following CSVT is associated with poorer overall outcomes.
Background:
Cerebral sinovenous thrombosis (CSVT) is a rare form of pediatric stroke with significant morbidity. We determined cumulative incidence and predictors of acute seizures, remote seizures, and epilepsy after pediatric CSVT.
Methods:
Retrospective analysis of 131 neonates and children with neuroimaging-confirmed CSVT enrolled between 2008 and 2020 from a single-center prospective consecutive cohort. Acute seizures occurred within 7 days of CSVT. Remote seizures occurred >7 days after CSVT. Epilepsy was defined as 2 or more remote seizures at least 24 hours apart. Survival methods determined the incidence of and risk factors for remote seizures and epilepsy.
Results:
Acute seizures occurred in 14/33 neonates (42%) and 19/98 children (19%). Among children, hemorrhage predicted acute seizures (OR 6.6, 95% CI 1.9 to 22.4, P = 0.003). Remote seizures occurred in six neonates; five developed epilepsy. Remote seizures occurred in 14 children; 10 developed epilepsy. In neonates, 1- and 3-year epilepsy-free survival were 86% (95% CI 62% to 95%) and 66% (95% CI 32% to 87%). One- and 3-year epilepsy-free survival in children were 88% (95% CI 76% to 92%) and 84% (95% CI 59% to 86%). In multivariable analysis for children, acute seizures predicted epilepsy (HR 3.8, 95% CI 1.1-13.3, P = 0.039). In both cohorts, Pediatric Stroke Outcome Measure scores at last follow-up were worse in those with epilepsy compared to those without.
Conclusions:
Acute seizures occurred in approximately one quarter of our cohort and are an epilepsy risk factor in children with CSVT. Neonates and children with epilepsy had worse outcomes than those without.
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