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 and 3 others
PMID 27422813WHAT IT FOUND
Children after stroke who had longer or more frequent acute seizures were more likely to have active epilepsy at one year.
Each extra 10 minutes of the longest seizure was linked to a five-fold higher risk.
Key findings
01Acute seizures were identified in 93% of neonates and 37% of children with confirmed arterial ischemic stroke.
02Each year younger than 18 at stroke onset was associated with a 20% higher likelihood of an acute seizure, with greater probability under 4 years of age.
03Longer and more frequent acute seizures after stroke were associated with active epilepsy: each additional 10 minutes of longest seizure increased risk five-fold, and more than 10 acute seizures increased risk 30-fold compared with no acute seizure.
STILL TO COME
How it was doneWhat they found
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What it does not show
The cohort was not population-based and was enrolled at tertiary stroke centers, so it may include more children with severe stroke or greater medical illness. Acute seizure timing, frequency, and duration were judged by site investigators, so some clinical or subclinical seizures may have been missed. Continuous EEG monitoring was not used for all patients, and EEG data were available only for a subset, so seizure burden may be underestimated. Follow-up was available for 109 of 114 enrolled patients, with three deaths and two losses to follow-up. Nearly half of the children were discharged on maintenance anticonvulsants, which may have prevented first remote seizures and obscured the natural course of epilepsy. The number of epilepsy outcomes was limited, so the authors did not build a multivariable model for active epilepsy.
The easy way to misread this
Do not conclude that preventing acute seizures with anti-convulsants or continuous EEG will reduce later epilepsy. This was an observational study of risk, not a trial of treatment.