title: Risk of later seizure after perinatal arterial ischemic stroke: a prospective cohort study.
abstract: OBJECTIVE
  Although acute seizures are common among neonates with arterial ischemic stroke (AIS), the incidence of subsequent seizures is unknown. The goals of this study were to determine the incidence of seizures following hospital discharge after perinatal acute AIS, and to assess lesion characteristics associated with later seizure occurrence.
  
  
  METHODS
  Neonates with confirmed acute AIS on MRI were identified through a prospective stroke registry. Clinic visits and telephone follow-up identified occurrence of seizures after hospital discharge. MRI scans were graded for size and characteristics of infarct, and associations with seizures after stroke were analyzed.
  
  
  RESULTS
  At a mean (SD) follow-up of 31.3 (16.1) months, 11 of 46 (23.9%) patients with perinatal AIS had at least 1 seizure. Five patients had a single episode of seizure, and 6 developed epilepsy. The Kaplan-Meier probability of remaining seizure-free at 3 years was 73%. Stroke size on MRI was significantly associated with development of later seizures, with an incidence rate of later seizures 6.2 times higher among those with larger stroke size.
  
  
  CONCLUSIONS
  Seizures occurred in <25% of patients during initial follow-up after perinatal AIS. Of those with seizures, nearly half had a single episode of seizure and not early epilepsy. Larger stroke size was associated with higher risk of seizure. These data suggest that prolonged treatment with anticonvulsant agents may not be indicated for seizure prophylaxis after perinatal AIS. These findings may help guide clinicians in counseling families and could form the basis for much-needed future research in this area.
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Colket Translational Research Building, Philadelphia, PA 19104, USA.
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Wusthoff
authors.forename: Sudha Kilaru
authors.initials: SK
authors.lastname: Kessler
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ichord
authors.forename: Sarah
authors.initials: S
authors.lastname: Zelonis
authors.forename: Aviva
authors.initials: A
authors.lastname: Halperin
authors.forename: Danielle
authors.initials: D
authors.lastname: Gordon
authors.forename: Gray
authors.initials: G
authors.lastname: Vargas
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
authors.forename: Sabrina E
authors.initials: SE
authors.lastname: Smith
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D014057:Tomography, X-Ray Computed