Abstracts

Rationale: The incidence of childhood stroke ranges from 2 to 8 in 100,000 per year in North America. The EEG in the acute setting of pediatric stroke is poorly characterized. In this study, we identify the incidence of seizures, EEG characteristics, and short-term outcome in patients presenting with an acute stroke at a tertiary care children’s hospital. Methods: Data was prospectively collected and retrospectively reviewed of patients presenting to a tertiary care children's hospital with an acute ischemic stroke (AIS), hemorrhagic stroke (HS), or cerebral sinus venous thrombosis (CSVT). Over a 3.5-year period, 77 patients were identified and charts were queried for demographics, stroke type, witnessed clinical seizure activity, and EEG characteristics. Results: The median age at presentation was 8.3 years (range: 2 months-18 years). 21% presented with clinical seizure activity, and an additional 10% had a clinical seizure during the acute hospitalization. 25% had a clinical seizure within the first 24 hours of presentation. Seizure incidence varied significantly among age, greatest in the 1 year - 5 years age group (p ≤ 0.001), but did not vary among sex or stroke subtype. Those with a clinical seizure had higher rates of focal epileptiform discharges, focal slowing, generalized slowing, and electrographic seizures on EEG than those without (p ≤ 0.001). Status epilepticus was common in those who had an EEG (17%), and was more common in infants. NCSE was captured only in patients with prolonged EEG monitoring, always starting within 24 hours of monitoring. Seizure incidence and NCSE did not vary among stroke subtype. 24% of children had recurrent seizures six months after their stroke. Conclusions: Pediatric stroke patients represent a population that is at high risk of seizure and encephalopathy. Patients are at greatest risk of a clinical seizure within the first 24 hours of presentation, and NCSE is common. Children with seizures in the first 24 hours of stroke onset are more likely to develop epilepsy.