Abstracts

Rationale: Seizure occurrence and epilepsy outcome have been studied following stroke in adults and neonates but data in children are limited. The objectives of the study were - 1).To determine the incidence, outcome, and risk factors for seizures after Arterial Ischemic Stroke (AIS) in children. 2).To determine the semiology of seizures at the time of presentation of stroke and during the post stroke period. Methods: 212 children diagnosed with AIS at Great Ormond Street Hospital (a tertiary pediatric neurology centre) between 1978 and 2000 were included1. Patients presenting between 1978 and 1990 were identified by a retrospective search of the hospital discharge database for International Classification of Diseases (ICD), 9th and 10th Revision. From 1990 onward, patients were identified and included prospectively. Seizures were classified according to the International League against Epilepsy criteria2. Recurrent stroke or transient ischaemic attack (TIA) and post-stroke seizures were documented and outcome was assessed using the modified Rankin scale (mRS). Results: 51/212 (24%) patients had seizures at presentation, most commonly generalised tonic-clonic (n=17, 2 with status epilepticus) and focal clonic (n=26). The age of those presenting with seizures was lower (median 2.5, range 1 month to 19 years) than those without seizures (median 5.5, range 3 months to 17 years). Seizures were more common in symptomatic (30/96) than in cryptogenic (21/116) stroke (Fisher’s exact test p=0.02) and in those with cortical stroke (p=0.002) and there was a trend for those with arteriopathy to be more likely to present with seizures (p=0.09). Twenty-three children (11%) had seizures after discharge, the majority generalised tonic-clonic (n=11) or focal clonic (n=6). Time to first non-acute seizure was shorter in those with acute seizures but this was not statistically significant (Log rank test p=0.3). Time to recurrent stroke or TIA was shorter in those who had not presented with acute seizures at the time of acute stroke (Log rank p=0.01). Death (n=8) or poor outcome (n=60 with mRS≥2) were more like in those with acute seizures (odds ratio 1.9, 95% confidence intervals 0.99, 3.6; p=0.05). Conclusions: Seizures occur at onset of stroke in a quarter of children affected, much higher than reported for adults, and recurrent seizures after discharge occur in one tenth but are not predicted by the presence of acute seizures. Acute seizures after stroke are commoner in younger children, symptomatic stroke and cortical infarction and appear to predict a lower risk of recurrent stroke and TIA. References: 1.Ganesan V et al. Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol.2003;53:167-73. 2.Blume WT et al. Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia. 2001;42:1212-8.