Epilepsy after stroke in childhood

Question: Little is known which factors may contribute to an increased risk for the development of an epilepsy after stroke in childhood (etiologies, localisation, extent of the damage). Unknown is whether seizures occurring in the acute phase do have a predictive value.

Methods: Data from 112 childhood stroke patients, admitted between 1986 and 2002 in our hospital (excluding perinatal and traumatic insults). Age of patients between 1 2/12 and 17 5/12 (average 8 7/12) years. Follow-up period 15 months and longer.

„Early seizures“=seizures ≤2 days after stroke.

Results:

A) Epilepsy with respect to etiology

Patients	Early seizures	Epilepsies (%)	Sharp waves in EEG
Stroke after Ischaemia N=66	1	20 (30)	4
Stroke after Haemorrhage N=46	2	17 (37)	4

B) Time of the first seizure and epilepsy (e.)

1. early seizures n=16(43%), thereof e. n=13(81%)

2. late seizures n=21(57%), thereof e. n=21(100%)

C) E. in relation to localisation and extent

E. after multi-regional infarctions: 5/8 (60%)

E. after MCA-infarctions: 22/42 (52%)

E. after basalganglia/ cerebellum insults: none

Discussion: Like in adults one third of the children suffering from an acute stroke will develop a focal epilepsy later-on. There is no difference between ischaemic and haemorrhagic lesions with respect to this issue. As expected, epilepsy does occur only in cases with cortical damages. The very high rate of epilepsy following “early seizures“ was unexpected.

Keywords: childhood stroke, MCA-infarction, early seizures