Department of Radiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Children's Clinic, Tartu University Hospital, Tartu, Estonia.
Epileptic Disord. 2024 Aug;26(4):471-483. doi: 10.1002/epd2.20239. Epub 2024 May 10.
Epilepsy develops in one third of the patients after perinatal stroke. It is still unclear which vascular syndrome of ischemic stroke carries higher risk of epilepsy. The aim of the current study was to evaluate the risk of epilepsy according to the vascular syndrome of perinatal stroke.
The study included 39 children with perinatal arterial ischemic stroke (13 with anterior or posterior trunk of the distal middle cerebral artery occlusion, 23 with proximal or distal M1 middle cerebral artery occlusion and three with lenticulostriate arteria infarction), and 44 children with presumed perinatal venous infarction. Magnetic resonance imaging obtained at the chronic stage was used to evaluate the vascular syndrome of stroke.
The median follow-up time was 15.1 years (95% CI: 12.4-16.5 years), epilepsy developed in 19/83 (22.9%) patients. The cumulative probability to be without epilepsy at 15 years was 75.4% (95% CI: 65.8-86.4). The probability of having epilepsy was higher in the group of proximal or distal M1 artery occlusion compared to patients with periventricular venous infarction (HR 7.2, 95% CI: 2.5-26, p = .0007). Patients with periventricular venous infarction had significantly more often status epilepticus or spike-wave activation in sleep ≥85% of it compared to patients with anterior or posterior trunk of the distal middle cerebral artery occlusion (OR = 81; 95% CI: 1.3-5046, p = .029).
The emphasis of this study is placed on classifying the vascular syndrome of perinatal stroke and on the targeted follow-up of patients for epilepsy until young adulthood. The risk for having epilepsy after perinatal stroke is the highest in children with proximal or distal M1 middle cerebral artery occlusion. Patients with periventricular venous infarction have a more severe course of epilepsy.
围产期卒中后，三分之一的患者会出现癫痫。目前尚不清楚哪种缺血性卒中的血管综合征癫痫风险更高。本研究旨在根据围产期卒中的血管综合征评估癫痫的风险。
本研究纳入了 39 例围产期动脉缺血性卒中患儿（13 例前或后循环远端大脑中动脉闭塞，23 例近端或远端大脑中动脉 M1 段闭塞，3 例纹状体动脉梗死）和 44 例疑似围产期静脉梗死患儿。使用慢性期磁共振成像评估卒中的血管综合征。
中位随访时间为 15.1 年（95%CI：12.4-16.5 年），83 例患者中有 19 例（22.9%）发生癫痫。15 年无癫痫的累积概率为 75.4%（95%CI：65.8-86.4）。与脑室周围静脉梗死患者相比，近端或远端大脑中动脉 M1 段闭塞患者发生癫痫的概率更高（HR 7.2，95%CI：2.5-26，p=0.0007）。与前或后循环远端大脑中动脉闭塞患者相比，脑室周围静脉梗死患者癫痫持续状态或睡眠中棘波激活≥85%的患者更常见（OR=81；95%CI：1.3-5046，p=0.029）。
本研究的重点是对围产期卒中的血管综合征进行分类，并对癫痫患儿进行针对性随访至成年早期。围产期卒中后癫痫风险最高的是近端或远端大脑中动脉 M1 段闭塞的患儿。脑室周围静脉梗死患者的癫痫病程更严重。
