title: Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke.
abstract: To determine incidence rates and risk factors of remote seizure after perinatal arterial ischemic stroke.
  
  
  
  We retrospectively identified a population-based cohort of children with perinatal arterial ischemic stroke (presenting acutely or in a delayed fashion) from a large Northern Californian integrated health care system. We determined incidence and predictors of a remote seizure (unprovoked seizure after neonatal period, defined as 28 days of life) by survival analyses, and measured epilepsy severity in those with active epilepsy (≥1 remote seizure and maintenance anticonvulsant treatment) at last follow-up.
  
  
  
  Among 87 children with perinatal stroke, 40 (46%) had a seizure in the neonatal period. During a median follow-up of 7.1 years (interquartile range 3.2-10.5), 37 children had ≥1 remote seizure. Remote seizure risk was highest during the first year of life, with a 20% (95% confidence interval [CI] 13%-30%) cumulative incidence by 1 year of age, 46% (CI 35%-58%) by 5 years, and 54% (CI 41%-67%) by 10 years. Neonatal seizures increased the risk of a remote seizure (hazard ratio 2.8, CI 1.3-5.8). Children with neonatal seizures had a 69% (CI 48%-87%) cumulative incidence of remote seizure by age 10 years. Among the 24 children with active epilepsy at last follow-up, 8 (33%) were having monthly seizures despite an anticonvulsant and 7 (29%) were on more than one anticonvulsant.
  
  
  
  Remote seizures and epilepsy, including medically refractory epilepsy, are common after perinatal stroke. Neonatal seizures are associated with nearly 3-fold increased remote seizure risk.
authors.affiliation: From the Departments of Neurology (C.K.F., H.C.G., H.J.F.), Pediatrics (C.K.F., H.C.G., H.J.F.), and Epidemiology and Biostatistics (H.C.G.), University of California, San Francisco; the Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; and the Division of Pediatric Neurology (S.E.S.), Kaiser Permanente Oakland Medical Center, CA. Christine.Fox@ucsf.edu.
authors.forename: Christine K
authors.initials: CK
authors.lastname: Fox
authors.affiliation: From the Departments of Neurology (C.K.F., H.C.G., H.J.F.), Pediatrics (C.K.F., H.C.G., H.J.F.), and Epidemiology and Biostatistics (H.C.G.), University of California, San Francisco; the Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; and the Division of Pediatric Neurology (S.E.S.), Kaiser Permanente Oakland Medical Center, CA.
authors.forename: Hannah C
authors.initials: HC
authors.lastname: Glass
authors.affiliation: From the Departments of Neurology (C.K.F., H.C.G., H.J.F.), Pediatrics (C.K.F., H.C.G., H.J.F.), and Epidemiology and Biostatistics (H.C.G.), University of California, San Francisco; the Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; and the Division of Pediatric Neurology (S.E.S.), Kaiser Permanente Oakland Medical Center, CA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.affiliation: From the Departments of Neurology (C.K.F., H.C.G., H.J.F.), Pediatrics (C.K.F., H.C.G., H.J.F.), and Epidemiology and Biostatistics (H.C.G.), University of California, San Francisco; the Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; and the Division of Pediatric Neurology (S.E.S.), Kaiser Permanente Oakland Medical Center, CA.
authors.forename: Sabrina E
authors.initials: SE
authors.lastname: Smith
authors.affiliation: From the Departments of Neurology (C.K.F., H.C.G., H.J.F.), Pediatrics (C.K.F., H.C.G., H.J.F.), and Epidemiology and Biostatistics (H.C.G.), University of California, San Francisco; the Division of Research (S.S.), Kaiser Permanente Northern California, Oakland; and the Division of Pediatric Neurology (S.E.S.), Kaiser Permanente Oakland Medical Center, CA.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Fullerton
mesh_terms: D002545:Brain Ischemia / Q000453:epidemiology*; D002140:California; D002547:Cerebral Palsy / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology*; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*