Perinatal Stroke May Be Associated With an Increased Risk for Epilepsy



A retrospective study of 124 patients with perinatal arterial stroke found that these patients have an increased risk for epilepsy.

ROME—Children with perinatal arterial ischemic stroke (PAS) have an increased risk for epilepsy, researchers reported at the 29th International Epilepsy Congress.

“Seizures are a frequent presenting sign of PAS, and childhood epilepsy is a frequent resulting morbidity, sometimes manifesting as a severe encephalopathy,” Martina Balestri, MD, a neurologist at the Bambino Gesù Pediatric Hospital, Rome, told Neurology Reviews.

Dr. Balestri and colleagues performed a retrospective analysis of data on 124 children with acute and delayed diagnosis of PAS, as documented by MRI. All patients were diagnosed at a tertiary care children’s hospital from 2004 to 2010.

The sample included 100 (80.6%) patients with a delayed presentation of PAS (at a mean age of 8 months) and 24 patients (19.3%) who were diagnosed with PAS at birth. PAS involved the middle cerebral artery in 121 (97.%) patients, occurring on the left side in 70 (58%) cases and on the right side in 51 (42%) cases.

Among all patients, 56 (45%) developed epilepsy, with a mean age of 30 months at epilepsy onset. Forty-four (78.5%) patients with epilepsy presented with focal seizures, three (5.3%) with generalized seizures, 15 (26.7%) with West syndrome, and six (10.7%) with infantile spasms and focal seizures. Thirty-two (57%) patients with epilepsy were treated successfully with antiepileptic drugs, while 24 (42.8%) of them were resistant to these drugs. Two (3.5%) patients with epilepsy were treated successfully with surgery.

Forty (40%) patients with delayed-onset PAS developed epilepsy, compared with 14 (70%) patients with neonatal onset. Of the patients with delayed onset, 86 (86%) presented with hemiparesis, seven (7%) presented with epilepsy, and seven (7%) had an MRI indicating unexplained psychomotor delay. Of the patients with neonatal onset, 20 (83.3%) presented with neonatal seizures.

“Seizures as a presenting sign of PAS may indicate a cerebral cortical involvement in stroke, and this may be a risk factor later on,” said Dr. Balestri. “Delayed PAS usually manifests with motor signs due to involvement of basal ganglia—subcortical cerebral structures—that is not epileptogenic.”

—Jack Baney

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