Abstracts

Rationale: Pediatric arterial ischemic stroke (AIS) is rare compared to adults, however may cause long term morbidity and mortality. We aimed to determine the occurrence of acute symptomatic seizures and the risk of developing epilepsy in children with AIS.  Methods: We retrospectively analysed children with AIS followed up at Hacettepe University Department of Pediatric Neurology between 2002-2017. We reviewed demographic features, examination findings, etiology, neuroimaging findings and outcome. As described previously, seizures during the first 48 hours after the onset of stroke symptoms were defined as early seizures. Epilepsy was defined as two or more unprovoked seizures separated by 24 hours, occurring greater than 48 hours but less than 2 years after stroke diagnosis. Patients were classified as non-epileptic if they had no seizures during the first 2 years. Probable epilepsy was defined as one unprovoked seizure and presence of either epileptiform discharge in EEG or initiation of antiepileptic drug therapy (AED). Results: We reviewed 94 patients with AIS; aged 1 month-18 years at the time of diagnosis (median age 4 years). Cardiac abnormalities (39%) and arteriopathies (33%) were the most common etiologies. 34 of 91 patients (37,4%) with sufficient data regarding occurrence of seizures, had early seizures. Patients with early seizures, were younger than those without seizures (median age 2 years versus 4,5 years; p=0,02). 16 of 68 patients with sufficient data (23,5%) had seizures after the first 48 hours and before 2 years, and 12 of 64 (18,8%) continued to have seizures beyond 2 years. We studied clinical (age, underlying disease, early seizures), etiologic (cardiac, arteriopathy), neuroimaging (anterior/posterior circulation, bilateral/unilateral infarcts, cortical/subcortical involvement, accompanying hemorrhage, affected brain region) features and use of antithrombotic therapy. Children who had epilepsy were significantly younger than patients without epilepsy (median age 1,5 years versus 4,5 years; p=0,03). Early seizures, bilateral infarcts, cortical involvement, occipital lobe infarcts were significantly more common in children who developed epilepsy. All children with epilepsy were started on AED upon discharge. Poor outcome (modified Rankin Scale=3) was more likely in patients with acute seizures and in patients who developed epilepsy.  Conclusions: Acute seizures and epilepsy are more common in children with AIS compared to adults. Younger children are at increased risk for these comorbidities.  Acute seizures increase risk for developing epilepsy. Further studies are needed to determine predictors and mechanisms underlying epilepsy in pediatric stroke survivors, and subsequently improve outcome. Funding: None