Epilepsy in children with delayed presentation of perinatal stroke

Karima C. Fitzgerald, Linda Williams, Bhuwan P. Garg, Meredith Golomb

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

A subgroup of children with perinatal stroke do not present clinically until after the perinatal period. Detailed epilepsy outcomes in these children have not been well studied. A retrospective cohort study of 45 children with delayed presentation of perinatal stroke identified by review of pediatric stroke clinic records, physician referral, and International Classification of Diseases, Ninth edition, code searches of hospital records, was performed at a tertiary pediatric hospital in Indianapolis, Indiana. A modified version of the Engel scale was used to grade epilepsy outcomes. The Χ2 test, Fisher's exact test, and relative risks were calculated to examine the association of epilepsy at time of last follow-up with initial presentation with seizures, infantile spasms, radiographic findings, and initial abnormal electroencephalogram (EEG). These tests were also used to examine the association of epilepsy with cognitive or motor disability and the association of initial abnormal EEG with motor disability. Patients presented with hemiparesis (40; 89%), seizures (4; 9%), or headaches (1; 2%). All had unilateral infarcts on cranial imaging. Four children (9%) had infantile spasms, 2 at presentation and 2 later. Nineteen children received at least 1 EEG for suspicious spells or frank seizures; initial EEG was abnormal in 16 patients (84%). At last follow-up, 17 patients (38%) had epilepsy, which was severe in 4 (24% of those with epilepsy). Initial presentation with seizures (relative risk = 3.2; 95% confidence interval, 2.0-4.9) and infantile spasms (relative risk = 3.2; confidence interval, 2.0-4.9) were associated with epilepsy at last follow-up. Infantile spasms were also associated with moderate-to-severe epilepsy at last follow-up (relative risk = 10.3; confidence interval, 1.9-54.4). Epilepsy at last follow-up was associated with cognitive disability (P = .05). Initial abnormal EEG was not associated with cerebral palsy (P = .30). Epilepsy is frequent in children with delayed presentation of perinatal stroke and is associated with initial presentation with seizures and infantile spasms at any point in time. Cognitive disability often accompanies epilepsy in these children.

Original languageEnglish
Pages (from-to)1274-1280
Number of pages7
JournalJournal of Child Neurology
Volume22
Issue number11
DOIs
StatePublished - Nov 2007

Fingerprint

Epilepsy
Stroke
Infantile Spasms
Electroencephalography
Seizures
Confidence Intervals
Pediatric Hospitals
Hospital Records
International Classification of Diseases
Paresis
Cerebral Palsy
Tertiary Care Centers
Headache
Cohort Studies
Referral and Consultation
Retrospective Studies
Pediatrics
Physicians

Keywords

  • Epilepsy
  • Infantile spasms
  • Perinatal
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health

Cite this

Epilepsy in children with delayed presentation of perinatal stroke. / Fitzgerald, Karima C.; Williams, Linda; Garg, Bhuwan P.; Golomb, Meredith.

In: Journal of Child Neurology, Vol. 22, No. 11, 11.2007, p. 1274-1280.

Research output: Contribution to journalArticle

Fitzgerald, Karima C. ; Williams, Linda ; Garg, Bhuwan P. ; Golomb, Meredith. / Epilepsy in children with delayed presentation of perinatal stroke. In: Journal of Child Neurology. 2007 ; Vol. 22, No. 11. pp. 1274-1280.
@article{2c6d0fd9560f49f39024dec4247ef52b,
title = "Epilepsy in children with delayed presentation of perinatal stroke",
abstract = "A subgroup of children with perinatal stroke do not present clinically until after the perinatal period. Detailed epilepsy outcomes in these children have not been well studied. A retrospective cohort study of 45 children with delayed presentation of perinatal stroke identified by review of pediatric stroke clinic records, physician referral, and International Classification of Diseases, Ninth edition, code searches of hospital records, was performed at a tertiary pediatric hospital in Indianapolis, Indiana. A modified version of the Engel scale was used to grade epilepsy outcomes. The Χ2 test, Fisher's exact test, and relative risks were calculated to examine the association of epilepsy at time of last follow-up with initial presentation with seizures, infantile spasms, radiographic findings, and initial abnormal electroencephalogram (EEG). These tests were also used to examine the association of epilepsy with cognitive or motor disability and the association of initial abnormal EEG with motor disability. Patients presented with hemiparesis (40; 89{\%}), seizures (4; 9{\%}), or headaches (1; 2{\%}). All had unilateral infarcts on cranial imaging. Four children (9{\%}) had infantile spasms, 2 at presentation and 2 later. Nineteen children received at least 1 EEG for suspicious spells or frank seizures; initial EEG was abnormal in 16 patients (84{\%}). At last follow-up, 17 patients (38{\%}) had epilepsy, which was severe in 4 (24{\%} of those with epilepsy). Initial presentation with seizures (relative risk = 3.2; 95{\%} confidence interval, 2.0-4.9) and infantile spasms (relative risk = 3.2; confidence interval, 2.0-4.9) were associated with epilepsy at last follow-up. Infantile spasms were also associated with moderate-to-severe epilepsy at last follow-up (relative risk = 10.3; confidence interval, 1.9-54.4). Epilepsy at last follow-up was associated with cognitive disability (P = .05). Initial abnormal EEG was not associated with cerebral palsy (P = .30). Epilepsy is frequent in children with delayed presentation of perinatal stroke and is associated with initial presentation with seizures and infantile spasms at any point in time. Cognitive disability often accompanies epilepsy in these children.",
keywords = "Epilepsy, Infantile spasms, Perinatal, Stroke",
author = "Fitzgerald, {Karima C.} and Linda Williams and Garg, {Bhuwan P.} and Meredith Golomb",
year = "2007",
month = "11",
doi = "10.1177/0883073807307106",
language = "English",
volume = "22",
pages = "1274--1280",
journal = "Journal of Child Neurology",
issn = "0883-0738",
publisher = "SAGE Publications Inc.",
number = "11",

}

TY - JOUR

T1 - Epilepsy in children with delayed presentation of perinatal stroke

AU - Fitzgerald, Karima C.

AU - Williams, Linda

AU - Garg, Bhuwan P.

AU - Golomb, Meredith

PY - 2007/11

Y1 - 2007/11

N2 - A subgroup of children with perinatal stroke do not present clinically until after the perinatal period. Detailed epilepsy outcomes in these children have not been well studied. A retrospective cohort study of 45 children with delayed presentation of perinatal stroke identified by review of pediatric stroke clinic records, physician referral, and International Classification of Diseases, Ninth edition, code searches of hospital records, was performed at a tertiary pediatric hospital in Indianapolis, Indiana. A modified version of the Engel scale was used to grade epilepsy outcomes. The Χ2 test, Fisher's exact test, and relative risks were calculated to examine the association of epilepsy at time of last follow-up with initial presentation with seizures, infantile spasms, radiographic findings, and initial abnormal electroencephalogram (EEG). These tests were also used to examine the association of epilepsy with cognitive or motor disability and the association of initial abnormal EEG with motor disability. Patients presented with hemiparesis (40; 89%), seizures (4; 9%), or headaches (1; 2%). All had unilateral infarcts on cranial imaging. Four children (9%) had infantile spasms, 2 at presentation and 2 later. Nineteen children received at least 1 EEG for suspicious spells or frank seizures; initial EEG was abnormal in 16 patients (84%). At last follow-up, 17 patients (38%) had epilepsy, which was severe in 4 (24% of those with epilepsy). Initial presentation with seizures (relative risk = 3.2; 95% confidence interval, 2.0-4.9) and infantile spasms (relative risk = 3.2; confidence interval, 2.0-4.9) were associated with epilepsy at last follow-up. Infantile spasms were also associated with moderate-to-severe epilepsy at last follow-up (relative risk = 10.3; confidence interval, 1.9-54.4). Epilepsy at last follow-up was associated with cognitive disability (P = .05). Initial abnormal EEG was not associated with cerebral palsy (P = .30). Epilepsy is frequent in children with delayed presentation of perinatal stroke and is associated with initial presentation with seizures and infantile spasms at any point in time. Cognitive disability often accompanies epilepsy in these children.

AB - A subgroup of children with perinatal stroke do not present clinically until after the perinatal period. Detailed epilepsy outcomes in these children have not been well studied. A retrospective cohort study of 45 children with delayed presentation of perinatal stroke identified by review of pediatric stroke clinic records, physician referral, and International Classification of Diseases, Ninth edition, code searches of hospital records, was performed at a tertiary pediatric hospital in Indianapolis, Indiana. A modified version of the Engel scale was used to grade epilepsy outcomes. The Χ2 test, Fisher's exact test, and relative risks were calculated to examine the association of epilepsy at time of last follow-up with initial presentation with seizures, infantile spasms, radiographic findings, and initial abnormal electroencephalogram (EEG). These tests were also used to examine the association of epilepsy with cognitive or motor disability and the association of initial abnormal EEG with motor disability. Patients presented with hemiparesis (40; 89%), seizures (4; 9%), or headaches (1; 2%). All had unilateral infarcts on cranial imaging. Four children (9%) had infantile spasms, 2 at presentation and 2 later. Nineteen children received at least 1 EEG for suspicious spells or frank seizures; initial EEG was abnormal in 16 patients (84%). At last follow-up, 17 patients (38%) had epilepsy, which was severe in 4 (24% of those with epilepsy). Initial presentation with seizures (relative risk = 3.2; 95% confidence interval, 2.0-4.9) and infantile spasms (relative risk = 3.2; confidence interval, 2.0-4.9) were associated with epilepsy at last follow-up. Infantile spasms were also associated with moderate-to-severe epilepsy at last follow-up (relative risk = 10.3; confidence interval, 1.9-54.4). Epilepsy at last follow-up was associated with cognitive disability (P = .05). Initial abnormal EEG was not associated with cerebral palsy (P = .30). Epilepsy is frequent in children with delayed presentation of perinatal stroke and is associated with initial presentation with seizures and infantile spasms at any point in time. Cognitive disability often accompanies epilepsy in these children.

KW - Epilepsy

KW - Infantile spasms

KW - Perinatal

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=36248941873&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=36248941873&partnerID=8YFLogxK

U2 - 10.1177/0883073807307106

DO - 10.1177/0883073807307106

M3 - Article

C2 - 18006956

AN - SCOPUS:36248941873

VL - 22

SP - 1274

EP - 1280

JO - Journal of Child Neurology

JF - Journal of Child Neurology

SN - 0883-0738

IS - 11

ER -