title: Prolonged or recurrent acute seizures after pediatric arterial ischemic stroke are associated with increasing epilepsy risk.
abstract: OBJECTIVE
  To determine epilepsy risk factors after pediatric stroke.
  
  
  METHODS
  A cohort of children with arterial ischemic stroke (birth-18y) was enrolled at 21 centers and followed for 1 year. Acute seizures (≤7d after stroke) and active epilepsy (at least one unprovoked remote seizure plus maintenance anticonvulsant at 1y) were identified. Predictors were determined using logistic regression.
  
  
  RESULTS
  Among 114 patients (28 neonates and 86 children) enrolled, 26 neonates (93%) and 32 children (37%) had an acute seizure. Acute seizures lasted longer than 5 minutes in 23 patients (40%) and were frequently recurrent: 33 (57%) had 2 to 10 seizures and 11 (19%) had more than 10. Among 109 patients with 1-year follow-up, 11 (10%) had active epilepsy. For each year younger, active epilepsy was 20% more likely (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-0.99, p=0.041). Prolonged or recurrent acute seizures also increased epilepsy risk. Each additional 10 minutes of the longest acute seizure increased epilepsy risk fivefold (OR 4.7, 95% CI 1.7-13). Patients with more than 10 acute seizures had a 30-fold increased epilepsy risk (OR 30, 95% CI 2.9-305).
  
  
  CONCLUSIONS
  Pediatric stroke survivors, especially younger children, have a high risk of epilepsy 1 year after stroke. Prolonged or recurrent acute seizures increase epilepsy risk in a dose-dependent manner.
authors.affiliation: Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.|Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Christine K
authors.initials: CK
authors.lastname: Fox
authors.affiliation: Department of Neurology, Royal Children's Hospital, Melbourne, Vic., Australia.|Murdoch Children's Research Institute, Melbourne, Vic., Australia.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Mackay
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.|Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dowling
authors.affiliation: Department of Neurology, Children's National Medical Center, Washington, DC, USA.
authors.forename: Paola
authors.initials: P
authors.lastname: Pergami
authors.affiliation: Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debrè Hospital, Paris, France.
authors.forename: Luigi
authors.initials: L
authors.lastname: Titomanlio
authors.affiliation: Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Deveber
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002545:Brain Ischemia / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009862:Online Systems; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*