Abstracts

Rationale: With an estimated incidence of 1 in 2300 to 5000 births, ischemic stroke is more likely to occur in the perinatal period than at any time in childhood. Little data are available on the risk and timing of developing epilepsy later in life. Methods: We retrospectively reviewed data of children with acute and delayed diagnosis of perinatal arterial stroke (PAS) in three tertiary care children s hospitals. Acute presentation of PAS was defined as neurological symptoms occurring before 28 days of life, whether children delayed presentation of PAS appeared neurologically normal in the neonatal period and then presented in infancy with neurological symptoms such as hemiparesis or seizures. Only patients with MRI-documented PAS were included. Over a 5-year period, 42 patients (23 females and 19 males) were identified and charts were queried for demographics, stroke type, clinical presentation, and subsequent development of epilepsy. Results: All 42 children (100%) had unilateral infarction in the left (28/42, 66%) or right (14/42, 33%) middle cerebral artery territory. 14/42 (33.3%) patients were diagnosed at birth, and 28 (66.6%) had a delayed presentation. Of those 28 babies with delayed presentation, 20 (71.4%) were diagnosed before 12 months of age, and 8 (28.5%) were diagnosed after 1 year of age. The mean age at presentation was 8.5 months (range 0-60 months). Of the 14 babies diagnosed at birth, 8 (57.1%) presented with seizures (2 of whom with focal status epilepticus), 5 (35.7 %) presented with respiratory distress, and one (7.1 %) with congenital palsy of the III cranial nerve. In the 28 patients with delayed presentation, hemiparesis was the most common neurological sign (26/28, 92.8%). In our cohort, 22/42 patients (52.3%) developed epilepsy later in life (mean age at onset 20.7 months, range 3 - 60 months), two (4.7%) had only one febrile seizure and another one (2.3%) had an episode of loss of consciousness, without a clear convulsion. Twelve patients out of 22 developed (54.5%) with focal epilepsy and 9 (40.9%) developed West syndrome. One patient (4.5%) presented with both focal seizures and West syndrome. More than 50% of patients presenting as neonates with seizures (5/8, 62.5%) developed epilepsy later in life, either focal epilepsy (3/5, 60%) or West syndrome (2/5, 40%). Mean age at onset of epilepsy was 22 months (range 6-36 months). In 12 (54.5%) patients epilepsy was easily controlled with AEDs. However, in 10/22 (45.4%) seizures remained uncontrolled despite AEDs polytherapy, and one of these children was successfully treated with surgery. Conclusions: Seizures are a frequent presenting sign of PAS. In our cohort, more than a half of patients acutely diagnosed presented with neonatal seizures. Childhood epilepsy is a frequent resulting morbidity. Epilepsy occurred later in life in more than 50% of patients, as focal epilepsy or epileptic encephalopathy. Drug-resistance among children with epilepsy following PAS is not uncommon and epilepsy surgery should be considered.