Bektaş Gonca, Kipoğlu Osman, Pembegül Yıldız Edibe, Aydınlı Nur, Çalışkan Mine, Özmen Meral, Sencer Serra
Division of Pediatric Neurology, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey.
Department of Pediatric Neurology, Istanbul Faculty of Medicine, Istanbul, Turkey.
Brain Dev. 2019 Sep;41(8):699-705. doi: 10.1016/j.braindev.2019.04.004. Epub 2019 Apr 16.
To identify the frequency of epilepsy and whether the association of epilepsy with clinical and neuroimaging findings in children with presumed perinatal arterial ischemic stroke (PPAIS).
We performed a retrospective analysis of 37 children with PPAIS followed-up at a tertiary referral center between January 1, 2000, and October 31, 2016. Clinical data including demographic features, age at onset of symptoms and seizures, initial clinical presentation, epilepsy features, used antiepileptic drugs, and thrombophilia screening results were abstracted from medical records. Brain magnetic resonance imaging scans were assessed for infarct laterality, location and affected brain regions.
The median age of the patients was 12 years (range 2-17.9 years) at last assessment. The initial symptom of PPAIS was early hand preference in 33 children (89%) and seizure in 4 children (11%). A total of 20 children (54%) developed epilepsy at a median age of 0.9 years. There were two peaks of epilepsy onset in infancy and adolescence. Fifteen children (41%) had focal epilepsy and 5 children (14%) had epileptic spasms. Twelve out of 20 children (60%) with epilepsy had drug resistant epilepsy. Cortical involvement was a statistically significant predictor of epilepsy (p = 0.021, relative risk 4.4, 95% confidence interval 0.7-27.7).
More than half of the children with PPAIS suffered from epilepsy during childhood, of whom developed drug resistant epilepsy in majority. Children with cortical lesion may have a higher risk to develop epilepsy.
确定癫痫的发生率，以及疑似围生期动脉缺血性卒中（PPAIS）患儿中癫痫与临床及神经影像学表现之间的关联。
我们对2000年1月1日至2016年10月31日期间在一家三级转诊中心接受随访的37例PPAIS患儿进行了回顾性分析。从病历中提取临床数据，包括人口统计学特征、症状和癫痫发作的起始年龄、初始临床表现、癫痫特征、使用的抗癫痫药物以及血栓形成倾向筛查结果。对脑磁共振成像扫描评估梗死的侧别、位置和受影响的脑区。
在最后一次评估时，患者的中位年龄为12岁（范围2 - 17.9岁）。PPAIS的初始症状在33例患儿（89%）中为早期偏手性，4例患儿（11%）为癫痫发作。共有20例患儿（54%）在中位年龄0.9岁时发生癫痫。癫痫发作有两个高峰，分别在婴儿期和青春期。15例患儿（41%）有局灶性癫痫，5例患儿（14%）有癫痫性痉挛。20例癫痫患儿中有12例（60%）为难治性癫痫。皮质受累是癫痫的一个具有统计学意义的预测因素（p = 0.021，相对风险4.4，95%置信区间0.7 - 27.7）。
超过一半的PPAIS患儿在儿童期患有癫痫，其中大多数发展为难治性癫痫。有皮质病变的患儿发生癫痫的风险可能更高。
