Lockrow Jason P, Wright Jason N, Saneto Russell P, Amlie-Lefond Catherine
Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA, USA.
Department of Neurology, Section of Neuroradiology, University of Washington, Seattle, WA, USA.
J Child Neurol. 2019 Nov;34(13):830-836. doi: 10.1177/0883073819863278. Epub 2019 Jul 24.
Perinatal stroke is a significant cause of severe epilepsy, including epileptic spasms. Although epileptic spasms due to underlying structural lesion often respond poorly to treatment and evolve into drug-resistant epilepsy, outcomes are not uniformly poor, and predictors of outcomes are not well described. We performed a single-institution retrospective review of epileptic spasms following perinatal stroke to determine if outcome depended on vascular subtype. We identified 24 children with epileptic spasms due to perinatal ischemic stroke: 11 cases of perinatal arterial stroke and 13 cases of perinatal venous infarct. Initial response to treatment was similar between groups; however, although children with perinatal arterial stroke who responded to epileptic spasms therapy had high rates of seizure freedom, many children with perinatal venous infarct, regardless of initial response, had residual drug-resistant epilepsy. We consider whether the mechanism for epileptogenesis may be different between arterial and venous strokes, and whether these 2 groups should be monitored for epileptic spasms, and subsequent epilepsy, differently.
围产期卒中是包括癫痫性痉挛在内的严重癫痫的重要病因。尽管由潜在结构性病变导致的癫痫性痉挛通常对治疗反应不佳并发展为药物难治性癫痫，但预后并非一律很差，且预后的预测因素尚无充分描述。我们对围产期卒中后的癫痫性痉挛进行了单机构回顾性研究，以确定预后是否取决于血管亚型。我们确定了24例因围产期缺血性卒中导致癫痫性痉挛的儿童：11例围产期动脉性卒中，13例围产期静脉梗死。两组对治疗的初始反应相似；然而，尽管对癫痫性痉挛治疗有反应的围产期动脉性卒中儿童癫痫发作缓解率很高，但许多围产期静脉梗死儿童，无论初始反应如何，都有残留的药物难治性癫痫。我们思考动脉性卒中和静脉性卒中之间的癫痫发生机制是否可能不同，以及这两组是否应采用不同的方式监测癫痫性痉挛及随后的癫痫。
