Department of Pediatric Neurology, Dokuz Eylul University, Faculty of Medicine, İzmir, Narlıdere, Turkey.
J Stroke Cerebrovasc Dis. 2021 Jan;30(1):105438. doi: 10.1016/j.jstrokecerebrovasdis.2020.105438. Epub 2020 Nov 13.
Acute seizures and post-stroke epilepsy have been reported more frequently in patients with pediatric stroke than adults. Acute seizures in the first days of a stroke may deteriorate stroke and ischemia-related neurodegeneration and contribute to the development of post-stroke epilepsy. In this study, we aimed to investigate risk factors for the development of post-stroke epilepsy in children with arterial ischemic stroke.
We recruited 86 children with arterial ischemic stroke. We analyzed variables, including age at admission, gender, complaints at presentation, focal or diffuse neurologic signs, neurologic examination findings, laboratory investigations that were conducted at admission with stroke (complete blood cell count, biochemical-infectious-metabolic-immunological investigations, vitamin B12 levels, vitamin D levels), neuroimaging results, etiologies, time of the first seizure, time of remote seizures, and development of neurologic deficit retrospectively. Seizures during the first six hours after stroke onset were defined as 'very early seizures'. 'Early seizures' were referred to seizures during the first 48 h. Patients who experienced two or more seizures that occurred after the acute phase of seizures were classified as 'epileptic.' A binary logistic regression analysis was used to estimate risk factors.
An acute seizure was detected in 59% and post-stroke epilepsy developed in 41% of our cohort. Binary logistic regression analysis demonstrated that 'very early seizures' increased epilepsy risk six-fold. Epilepsy was 16 times higher in patients with 'early seizures'. Low vitamin D levels were defined as a risk factor for post-stroke epilepsy.
Seizures in the very early period (within the first six hours) are the most significant risk factors for the development of post-stroke epilepsy Further studies regarding seizure prevention and neuroprotective therapies are needed because post-stroke epilepsy will affect long term prognosis in patients with pediatric stroke.
与成人相比，儿科脑卒中患者更常出现急性发作和卒中后癫痫。卒中后早期的急性发作可能使卒中恶化和与缺血相关的神经退行性变，并导致卒中后癫痫的发生。本研究旨在探讨动脉性缺血性卒中患儿发生卒中后癫痫的危险因素。
我们纳入了 86 例动脉性缺血性卒中患儿。我们分析了变量，包括入院时年龄、性别、发病时的主诉、局灶或弥漫性神经体征、神经检查结果、入院时进行的实验室检查（全血细胞计数、生化-感染-代谢-免疫检查、维生素 B12 水平、维生素 D 水平）、神经影像学结果、病因、首次发作时间、远程发作时间以及神经功能缺损的发展情况。卒中发病后 6 小时内的发作定义为“非常早期发作”。“早期发作”指的是 48 小时内的发作。在急性发作后经历两次或两次以上发作的患者被归类为“癫痫”。使用二项逻辑回归分析来评估危险因素。
我们的队列中，59%的患儿出现急性发作，41%的患儿发生卒中后癫痫。二项逻辑回归分析表明，“非常早期发作”使癫痫风险增加了 6 倍。“早期发作”患者的癫痫风险增加了 16 倍。低维生素 D 水平被定义为卒中后癫痫的危险因素。
早期（发病后 6 小时内）发作是发生卒中后癫痫的最重要危险因素。需要进一步研究癫痫预防和神经保护治疗，因为卒中后癫痫会影响儿科卒中患者的长期预后。
