Prolonged or recurrent acute seizures after pediatric arterial ischemic stroke are associated with increasing epilepsy risk

Christine K. Fox, Mark T. Mackay, Michael M. Dowling, Paola Pergami, Luigi Titomanlio, Gabrielle Deveber

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aim: To determine epilepsy risk factors after pediatric stroke. Method: A cohort of children with arterial ischemic stroke (birth-18y) was enrolled at 21 centers and followed for 1 year. Acute seizures (≤7d after stroke) and active epilepsy (at least one unprovoked remote seizure plus maintenance anticonvulsant at 1y) were identified. Predictors were determined using logistic regression. Results: Among 114 patients (28 neonates and 86 children) enrolled, 26 neonates (93%) and 32 children (37%) had an acute seizure. Acute seizures lasted longer than 5 minutes in 23 patients (40%) and were frequently recurrent: 33 (57%) had 2 to 10 seizures and 11 (19%) had more than 10. Among 109 patients with 1-year follow-up, 11 (10%) had active epilepsy. For each year younger, active epilepsy was 20% more likely (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-0.99, p=0.041). Prolonged or recurrent acute seizures also increased epilepsy risk. Each additional 10 minutes of the longest acute seizure increased epilepsy risk fivefold (OR 4.7, 95% CI 1.7-13). Patients with more than 10 acute seizures had a 30-fold increased epilepsy risk (OR 30, 95% CI 2.9-305). Interpretation: Pediatric stroke survivors, especially younger children, have a high risk of epilepsy 1 year after stroke. Prolonged or recurrent acute seizures increase epilepsy risk in a dose-dependent manner.

Original languageEnglish (US)
JournalDevelopmental Medicine and Child Neurology
DOIs
StateAccepted/In press - 2016

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Epilepsy
Seizures
Stroke
Pediatrics
Odds Ratio
Confidence Intervals
Newborn Infant
Anticonvulsants
Survivors
Logistic Models
Maintenance
Parturition

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience
  • Clinical Neurology

Cite this

Prolonged or recurrent acute seizures after pediatric arterial ischemic stroke are associated with increasing epilepsy risk. / Fox, Christine K.; Mackay, Mark T.; Dowling, Michael M.; Pergami, Paola; Titomanlio, Luigi; Deveber, Gabrielle.

In: Developmental Medicine and Child Neurology, 2016.

Research output: Contribution to journalArticle

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abstract = "Aim: To determine epilepsy risk factors after pediatric stroke. Method: A cohort of children with arterial ischemic stroke (birth-18y) was enrolled at 21 centers and followed for 1 year. Acute seizures (≤7d after stroke) and active epilepsy (at least one unprovoked remote seizure plus maintenance anticonvulsant at 1y) were identified. Predictors were determined using logistic regression. Results: Among 114 patients (28 neonates and 86 children) enrolled, 26 neonates (93{\%}) and 32 children (37{\%}) had an acute seizure. Acute seizures lasted longer than 5 minutes in 23 patients (40{\%}) and were frequently recurrent: 33 (57{\%}) had 2 to 10 seizures and 11 (19{\%}) had more than 10. Among 109 patients with 1-year follow-up, 11 (10{\%}) had active epilepsy. For each year younger, active epilepsy was 20{\%} more likely (odds ratio [OR] 0.8, 95{\%} confidence interval [CI] 0.6-0.99, p=0.041). Prolonged or recurrent acute seizures also increased epilepsy risk. Each additional 10 minutes of the longest acute seizure increased epilepsy risk fivefold (OR 4.7, 95{\%} CI 1.7-13). Patients with more than 10 acute seizures had a 30-fold increased epilepsy risk (OR 30, 95{\%} CI 2.9-305). Interpretation: Pediatric stroke survivors, especially younger children, have a high risk of epilepsy 1 year after stroke. Prolonged or recurrent acute seizures increase epilepsy risk in a dose-dependent manner.",
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AU - Titomanlio, Luigi

AU - Deveber, Gabrielle

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N2 - Aim: To determine epilepsy risk factors after pediatric stroke. Method: A cohort of children with arterial ischemic stroke (birth-18y) was enrolled at 21 centers and followed for 1 year. Acute seizures (≤7d after stroke) and active epilepsy (at least one unprovoked remote seizure plus maintenance anticonvulsant at 1y) were identified. Predictors were determined using logistic regression. Results: Among 114 patients (28 neonates and 86 children) enrolled, 26 neonates (93%) and 32 children (37%) had an acute seizure. Acute seizures lasted longer than 5 minutes in 23 patients (40%) and were frequently recurrent: 33 (57%) had 2 to 10 seizures and 11 (19%) had more than 10. Among 109 patients with 1-year follow-up, 11 (10%) had active epilepsy. For each year younger, active epilepsy was 20% more likely (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-0.99, p=0.041). Prolonged or recurrent acute seizures also increased epilepsy risk. Each additional 10 minutes of the longest acute seizure increased epilepsy risk fivefold (OR 4.7, 95% CI 1.7-13). Patients with more than 10 acute seizures had a 30-fold increased epilepsy risk (OR 30, 95% CI 2.9-305). Interpretation: Pediatric stroke survivors, especially younger children, have a high risk of epilepsy 1 year after stroke. Prolonged or recurrent acute seizures increase epilepsy risk in a dose-dependent manner.

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