Predictors of Drug-Resistant Epilepsy After Perinatal Stroke

Area of Science:

• Pediatric Neurology
• Epileptology
• Neuroscience

Background:

• Perinatal ischemic stroke (PIS) is a significant cause of childhood neurological deficits.
• Identifying predictors of drug-resistant epilepsy (DRE) in children with PIS is crucial for timely intervention.

Purpose of the Study:

• To identify predictors of DRE in children with a history of PIS.
• To evaluate the neurological outcomes and surgical success rates in children with PIS-related epilepsy.

Main Methods:

• Retrospective observational study of 96 children with PIS (2012-2023).
• DRE defined as seizures unresponsive to ≥2 antiseizure medications.
• Analysis included neuroimaging, medical records, and the Pediatric Stroke Outcome Measure (PSOM).

Main Results:

• 56% of children with PIS developed epilepsy; 21% had DRE.
• Hippocampal volume reduction was the sole predictor of DRE (OR 6.45, P=0.004).
• 65% of children with DRE underwent epilepsy surgery, with 62% achieving favorable seizure outcomes.

Conclusions:

• Hippocampal volume reduction is a strong predictor of DRE after PIS.
• Epilepsy and DRE are more prevalent in older children with PIS.
• Epilepsy surgery, including hemispherectomy and focal resections, offers favorable seizure outcomes.