Perinatal Stroke and the Risk of Developing Childhood Epilepsy

Golomb, Meredith R.; Garg, Bhuwan P.; Carvalho, Karen S.; Johnson, Cynthia S.; Williams, Linda S.

doi:10.1016/j.jpeds.2007.03.058

« Previous Next »The Journal of Pediatrics
Volume 151, Issue 4 , Pages 409-413.e2, October 2007

Perinatal Stroke and the Risk of Developing Childhood Epilepsy

Meredith R. Golomb, MD, MSc
- Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis, Indiana
- Dr Golomb is supported by the National Institutes of Health NINDS grant K23 NS048024 and the Clarian Values Fund grant VFR-171.
- Reprint requests: Dr Meredith Golomb, MD, MSc, Indiana University School of Medicine, Building XE, Room 040 (Pediatric Neurology), 575 West Dr., Indianapolis, IN 46202.
Bhuwan P. Garg, MBBS
- Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis, Indiana
Karen S. Carvalho, MD
- Division of Pediatric Neurology, Indiana University School of Medicine, Indianapolis, Indiana
Cynthia S. Johnson, MAc
- Division of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
Linda S. Williams, MD
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
- Roudebush VAMC, Indiana University School of Medicine, Indianapolis, Indiana
- The Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana.
- Dr Williams is supported by the National Institutes of Health NINDS R01 NS 39571 and a VA Health Services Research and Development Career Award.

Received 23 August 2006; received in revised form 1 February 2007; accepted 26 March 2007. published online 24 August 2007.

Objectives

To describe the prevalence of epilepsy after 6 months of age in children with perinatal stroke and examine whether perinatal data predict epilepsy onset and resolution.

Study design

A retrospective review of 64 children with perinatal stroke. In children with at least 6 months of follow-up data, Kaplan-Meier curves, univariate log-rank tests, and Cox proportional hazards models were used to examine predictors of time to development of seizures, and time to resolution of seizures in children with epilepsy. The association of risk factors with the presence of epilepsy at any time after 6 months of age was examined using Fisher’s exact test.

Results

Forty-one of the 61 children with at least 6 months of follow-up data (67%) had epilepsy between 6 months of age and last follow-up, but in 13 of 41, seizures eventually resolved and anticonvulsants were discontinued. Infarct on prenatal ultrasonography (P = .0065) and family history of epilepsy (P = .0093) were significantly associated with time to development of seizures after 6 months of age in the univariate analysis. No assessed variables were associated with time to resolution of epilepsy or with the presence of epilepsy after 6 months of age.

Conclusions

Childhood epilepsy is frequent after perinatal stroke. Evidence of infarction on prenatal ultrasonography and a family history of epilepsy predict earlier onset of active seizures.

EEG, Electroencephalogram, MCA, Middle cerebral artery, ME, Modified Engel, NICU, Neonatal intensive care unit