Seizures in Ischemic Strokes in Children
Abstract number :
1.153
Submission category :
Year :
2001
Submission ID :
919
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
A. Mehdi, MD, Neurology, University of Southern California, Los Angeles, CA; D.Y. Ko, MD, Neurology, University of Southern California, Los Angeles, CA; W. Mitchell, MD, Neurology, Children Hospital of Los Angeles, Los Angeles, CA
RATIONALE: To evaluate the incidence of seizures in children with acute ischemic stroke.
METHODS: A retrospective chart review of patients diagnosed with ischemic stroke at Children Hospital of Los Angeles in the past 10 years identified 33 patients with acute ischemic stroke. Hemorrhagic strokes have been reported to have higher incidence of seizures and sometimes is associated with head trauma, which is another risk for seizures, thus only ischemic strokes were identified for this study.
RESULTS: Seizures occurred in 24 (72.7%) of 33 patients with ischemic stroke. The etiology of stroke varied including infectious etiology 7 (21.2%), congenital heart disease 6 (18.1%), sickle cell disease 4 (12.1%), coagulation disorders 2 (6%), mitochondrial disorder 2 (6%), metabolic disorders 1 (3%), vasculitis 1 (3%), moya-moya syndrome 1 (3%) and idiopathic causes 9 (27.2%). Infectious etiology 7 (29.1%) of 24 was the most common cause of stroke with seizures. Of the patients with seizures the infarct location was cortical in 18 (75%) and subcortical in 6 (25%) patients. Seizures were seen on initial presentation in 23 patients while one patient had late onset seizure. The 24 patients with seizures, 6 (25%) had focal seizures and 18 (75%) had generalized tonic clonic seizures, which were probably secondarily generalized. Status epilepticus was not seen. EEG was abnormal in 14 (58.3%) patients with epileptic discharges 7 and background slowing 7 patients. Only one patient had previous history of seizures, due to citrullemia and this patient died of complication of stroke and underlying disease. At time of discharge from the hospital, 19 (79.1%) were left on antiepileptic medication.
Due to limited continuity in some patients it was difficult to determine what percentage of these patients developed epilepsy, recurrent seizures.
CONCLUSIONS: Seizures are a very common manifestation of ischemic stroke in children. The 72% incidence of seizures in children with stroke is much higher than the reported 2%-11% seizures in adults with stroke. Seizures were also present in patients with subcortical infarcts suggesting an increase cortical irritability. Incidence of seizures is much higher in children with stroke than adults and reflects the different etiologies such as the higher incidence of infectious etiology as well as disorders like mitochondrial disease, which can cause both stroke and seizures. Stroke evaluation should be considered in appropriate cases of children with seizures.