title: Incidence and predictors of epilepsy after pediatric arterial ischemic stroke.
abstract: OBJECTIVE
  To determine the cumulative incidence and clinical predictors of remote symptomatic seizures and epilepsy after pediatric arterial ischemic stroke (AIS).
  
  
  METHODS
  We performed a retrospective analysis of 218 participants with neonatal AIS (NAIS), presumed perinatal AIS (PPAIS), and childhood AIS (CAIS) from a single-center prospective consecutive cohort enrolled from 2006 to 2014. Medical records were reviewed for timing, semiology, and treatment of acute symptomatic seizures, remote symptomatic seizures (RSS), and epilepsy. Cumulative incidence of RSS and epilepsy were assessed using survival analysis.
  
  
  RESULTS
  Acute symptomatic seizures occurred in 94% of NAIS (n = 70/74) and 17% of CAIS (n = 18/105). Younger children were more likely to present with seizures at stroke ictus, and acute symptomatic seizures were predictive of later RSS and epilepsy in CAIS. Median follow-up for the entire cohort was 34 months, interquartile range 44.9 months (16.3-61.2). Estimated cumulative incidence of RSS at 2 years was 19% in NAIS, 24% in PPAIS, and 7% in CAIS. Estimated cumulative incidence of epilepsy at 2 years was 11% in NAIS, 19% in PPAIS, and 7% in CAIS. The median time to these outcomes was <2 years in all stroke subtypes. Among participants developing epilepsy (n = 34), seizures were often well-controlled at last follow-up with median Engel class of ≤2 (<1 seizure/month).
  
  
  CONCLUSIONS
  RSS and epilepsy are important neurologic sequelae of pediatric AIS. Children with perinatal stroke and CAIS with acute symptomatic seizures are at increased risk of these outcomes. These cohorts need further study to identify biomarkers and potential therapeutic targets for epileptogenesis.
authors.affiliation: From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA. billinghurstl@email.chop.edu.
authors.forename: Lori L
authors.initials: LL
authors.lastname: Billinghurst
authors.affiliation: From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.affiliation: From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
authors.affiliation: From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA.
authors.forename: Michael
authors.initials: M
authors.lastname: Uohara
authors.affiliation: From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA.
authors.forename: Laura
authors.initials: L
authors.lastname: Jastrzab
authors.affiliation: From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Licht
authors.affiliation: From the Division of Neurology (L.L.B., L.A.B., N.S.A., L.J., D.J.L., R.N.I.), The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; and Temple University School of Medicine (M.U.), Philadelphia, PA.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Ichord
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000453:epidemiology*