Navigating pediatric post-stroke epilepsy: comparative assessment of treatment strategies
Çağatay Günay1,2, Semra Hız Kurul3, Uluç Yiş3
1Department of Pediatric Neurology, Siirt Training and Research Hospital, Siirt, Turkey. cagataygunaymd@gmail.com.
Insights
Carbamazepine may be more effective than levetiracetam for managing pediatric post-stroke epilepsy (PSE). Acute stroke therapies do not impact PSE development, but carbamazepine offers better seizure control and higher medication discontinuation rates.
Area of Science:
- Neurology
- Pediatric Neurology
- Epileptology
Background:
- Post-stroke epilepsy (PSE) is a common and challenging complication in children.
- Optimal management strategies for pediatric PSE following arterial ischemic stroke require further investigation.
Purpose of the Study:
- To evaluate the impact of various treatment modalities and antiseizure medications (ASMs) on the development and management of pediatric PSE.
- To compare the efficacy of carbamazepine and levetiracetam in controlling seizures and achieving remission in pediatric PSE.
Main Methods:
- Retrospective cohort analysis of pediatric patients with arterial ischemic stroke over 20 years.
- Exclusion criteria included neonatal stroke, hemorrhagic stroke, and sinovenous thrombosis.
- ASMs evaluated for PSE management included levetiracetam and carbamazepine.
Main Results:
- Carbamazepine was associated with a lower PSE rate (45.1%) compared to levetiracetam (66.7%).
- Carbamazepine demonstrated superior seizure freedom at 6 and 24 months and higher efficacy in dose titration for seizure control.
- Higher ASM discontinuation rates were observed with carbamazepine (95.7%) compared to levetiracetam (79.4%).
Conclusions:
- Acute stroke therapies, anti-edema, and antithrombotic treatments did not reduce PSE development.
- Carbamazepine appears more effective than levetiracetam for pediatric PSE management, offering better seizure control and higher discontinuation rates.
- Further research is warranted to validate these findings and optimize PSE treatment protocols.
Background:
Although post-stroke epilepsy (PSE) is a prevalent complication in children, optimal management remains challenging. This study evaluated the impact of different treatment modalities and antiseizure medications (ASM) on the development and management of pediatric PSE following arterial ischemic stroke.
Methods:
We conducted a retrospective cohort analysis over 20 years, examining pediatric patients who experienced seizures during the course of arterial ischemic stroke. Exclusions included neonatal stroke, hemorrhagic stroke, and sinovenous thrombosis. Cut-off point of seven days were accepted as early seizures and PSE. Treatments included acute stroke therapies such as intravenous tissue plasminogen activator, mechanical thrombectomy, anti-edema therapies, and antithrombotic treatments. Medications for seizure control were categorized as acute seizure management agents (benzodiazepines and phenytoin), which are not used for long-term post-stroke epilepsy control, and long-term antiseizure medications (levetiracetam and carbamazepine) for PSE management.
Results:
Among 153 patients, 99 were male, with a median age of 23 months. PSE was diagnosed in 59.5% of the cohort. Cardiac disorders were the primary etiology (32.7%). Hyperacute treatments and anti-edema therapies showed no significant impact on PSE development. Benzodiazepines and phenytoin also did not affect PSE rates. Levetiracetam was associated with a higher PSE rate (66.7%) compared to carbamazepine (45.1%) (p = 0.010). Carbamazepine demonstrated superior seizure freedom at 6 and 24 months (p = 0.024 and p = 0.014, respectively). Seizure control was achieved in 19.8% of PSE patients through dose titration, with carbamazepine showing higher efficacy (p = 0.037). ASM discontinuation rates were higher with carbamazepine (95.7%) compared to levetiracetam (79.4%).
Conclusion:
Acute stroke therapies, anti-edema, and antithrombotic treatments did not lower the PSE development. Benzodiazepines and phenytoin were not effective in preventing PSE. Carbamazepine may be more effective than levetiracetam in managing pediatric PSE, providing better seizure control and higher ASM discontinuation rates. Further research is needed to confirm these findings.
