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03-01-2024 | Cerebral Ischemia | RESEARCH

Three-year incidence and acute setting predictors of epilepsy after neonatal and childhood arterial ischaemic stroke: a disease-based cohort study

Authors: Mauricio Lopez-Espejo, Ilona Skorin, Tomas Mesa, Marta I Hernandez-Chavez

Published in: European Journal of Pediatrics | Issue 3/2024

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Abstract

To assess the association between clinical and MRI characteristics of arterial ischaemic stroke (AIS) and the 3-year risk of post-stroke epilepsy (PSE) in paediatric patients. Retrospective cohort study. Database from a single tertiary referral centre for paediatric stroke in Chile. Two hundred seven neonates and children (1 day to 18 years) with a first-ever supratentorial AIS diagnosed between January 2003 and December 2019 were evaluated. Diagnosis of PSE and explanatory variables were consecutively recorded from hospital inpatient and annual outpatient records in a predesigned database. Competing risk analysis (competing events: death and loss to follow-up) of multiple Cox proportional hazards regression was performed to estimate adjusted subhazard ratios (SHRs) of PSE. Confidence intervals (95% CI) were calculated using bootstrap resampling (1000 replications). Interaction terms were added to investigate moderating effects. The 3-year incidence rate of PSE was 166.5 per 1000 person-years (neonatal: 150.1; childhood: 173.9). The 3-year cumulative incidence was 33%. Patients with acute symptomatic non-status seizures (SHR = 3.13; 95% CI = 1.43–6.82), status epilepticus (SHR = 5.16; 95% CI = 1.90–13.96), abnormal discharge neurological status (SHR = 2.52; 95% CI = 1.12–5.63), cortical lesions (SHR = 2.93; 95% CI = 1.48–5.81), and multifocal infarcts with stroke size < 5% of supratentorial brain volume (SHR = 3.49; 95% CI = 1.44–8.46) had a higher risk of PSE.
Conclusion: This study identified specific and reliable acute clinical and imaging predictors of PSE in paediatric patients, helping clinicians identify high-risk patients with potential implications for treatment decisions.
What is Known:
• Numerous risk factors have been proposed for post-stroke epilepsy, but there is a lack of studies evaluating these variables while accounting for confounding factors and competing risks over time.
What is New:
• After adjustment for competing events, acute symptomatic seizures, both non-status and status epilepticus, abnormal mental status or motor neurological examination at hospital discharge, cortical involvement, and multifocal ischaemic lesions in small strokes are all independent predictors of post-stroke epilepsy.
• Knowing the predictors of post-stroke epilepsy is essential for clinicians to make well-informed and effective decisions about treatment.
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Literature
Metadata
Title
Three-year incidence and acute setting predictors of epilepsy after neonatal and childhood arterial ischaemic stroke: a disease-based cohort study
Authors
Mauricio Lopez-Espejo
Ilona Skorin
Tomas Mesa
Marta I Hernandez-Chavez
Publication date
03-01-2024
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 3/2024
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-023-05384-4

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