Billinghurst Lori L, Beslow Lauren A, Abend Nicholas S, Uohara Michael, Jastrzab Laura, Licht Daniel J, Ichord Rebecca N
From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA.
Neurology. 2017 Feb 14;88(7):630-637. doi: 10.1212/WNL.0000000000003603. Epub 2017 Jan 13.
To determine the cumulative incidence and clinical predictors of remote symptomatic seizures and epilepsy after pediatric arterial ischemic stroke (AIS).
We performed a retrospective analysis of 218 participants with neonatal AIS (NAIS), presumed perinatal AIS (PPAIS), and childhood AIS (CAIS) from a single-center prospective consecutive cohort enrolled from 2006 to 2014. Medical records were reviewed for timing, semiology, and treatment of acute symptomatic seizures, remote symptomatic seizures (RSS), and epilepsy. Cumulative incidence of RSS and epilepsy were assessed using survival analysis.
Acute symptomatic seizures occurred in 94% of NAIS (n = 70/74) and 17% of CAIS (n = 18/105). Younger children were more likely to present with seizures at stroke ictus, and acute symptomatic seizures were predictive of later RSS and epilepsy in CAIS. Median follow-up for the entire cohort was 34 months, interquartile range 44.9 months (16.3-61.2). Estimated cumulative incidence of RSS at 2 years was 19% in NAIS, 24% in PPAIS, and 7% in CAIS. Estimated cumulative incidence of epilepsy at 2 years was 11% in NAIS, 19% in PPAIS, and 7% in CAIS. The median time to these outcomes was <2 years in all stroke subtypes. Among participants developing epilepsy (n = 34), seizures were often well-controlled at last follow-up with median Engel class of ≤2 (<1 seizure/month).
RSS and epilepsy are important neurologic sequelae of pediatric AIS. Children with perinatal stroke and CAIS with acute symptomatic seizures are at increased risk of these outcomes. These cohorts need further study to identify biomarkers and potential therapeutic targets for epileptogenesis.
确定小儿动脉缺血性卒中（AIS）后远期症状性癫痫发作和癫痫的累积发病率及临床预测因素。
我们对2006年至2014年纳入的单中心前瞻性连续队列中的218例新生儿AIS（NAIS）、疑似围产期AIS（PPAIS）和儿童期AIS（CAIS）参与者进行了回顾性分析。查阅病历以了解急性症状性癫痫发作、远期症状性癫痫发作（RSS）和癫痫的发作时间、症状学及治疗情况。使用生存分析评估RSS和癫痫的累积发病率。
94%的NAIS（n = 70/74）和17%的CAIS（n = 18/105）出现急性症状性癫痫发作。年龄较小的儿童在卒中发作时更易出现癫痫发作，且急性症状性癫痫发作可预测CAIS患儿日后出现RSS和癫痫。整个队列的中位随访时间为34个月，四分位间距为44.9个月（16.3 - 61.2）。NAIS患儿2年时RSS的估计累积发病率为19%，PPAIS为24%，CAIS为7%。NAIS患儿2年时癫痫的估计累积发病率为11%，PPAIS为19%，CAIS为7%。所有卒中亚型出现这些结局的中位时间均<2年。在发生癫痫的参与者（n = 34）中，末次随访时癫痫发作通常得到良好控制，中位Engel分级≤2（每月发作<1次）。
RSS和癫痫是小儿AIS重要的神经后遗症。围产期卒中和伴有急性症状性癫痫发作的CAIS患儿出现这些结局的风险增加。这些队列需要进一步研究以确定癫痫发生的生物标志物和潜在治疗靶点。
