The prevalence and severity of epilepsy after 6 months of age in 64 children with a history of perinatal stroke were studied by a retrospective review of patients at Riley Hospital for Children, Indianapolis, IN. Forty eight (75%) presented in the NICU with seizures and were treated with phenobarbital. Comorbidities included infection in 11 (17%), cardiac abnormalities in 11 (17%), ECMO in 4 (6%), and renal failure in 3 (5%). Seven (11%) had a family history of seizures. Prenatal ultrasound was positive for stroke in 4 (6%) patients. Infarction was confirmed by CT or MRI, and an abnormal initial EEG was recorded in 40 (91%). Follow-up data were available on 61 (95%) patients, and 41 (67%) had developed epilepsy between 6 months and last follow-up (mean 43 mos; range 9-178 mos). Five (8%) had infantile spasms. Seizures resolved in 13 (32% of 41 with epilepsy), and medications had been discontinued. Infarct on prenatal ultrasound (p=.0065) and family history of seizures (p=.0093) were significantly associated with an earlier development of seizures after 6 months of age: median time 3.8 months with, vs 53.9 without, positive ultrasound; and 1.1 months with, vs 53.9 without, positive family history. No variables were correlated with time to resolution of seizures, or with epilepsy occurrence after 6 months of age. [1]

COMMENT. Perinatal stroke is frequently followed by the development of epilepsy in childhood. Evidence of infarction on prenatal ultrasonography and a family history of epilepsy are predictive of an earlier onset of seizures, but no risk factors used in this study predicted time of seizure resolution or whether the patients would devlop epilepsy.

Frequency of electrographic seizures and PEDS after intracerebral hemorrhage was studied in 102 consecutive adult patients with ICH who underwent continuous electroencephalographic monitoring (cEEG) at Columbia University, NY [2]. Seizures occurred in one third of patients with ICH and more than one half were purely electrographic seizures. Electrographic seizures were associated with expanding hemorrhages, and PEDs were independently associated with cortical ICH and poor outcome. Continuous EEG monitoring is essential for detection of subtle seizures.

NIH Workshop on Ischemic Perinatal Stroke (IPS) is summarized by Raju TNK, Nelson KB and other participants [3]. The estimated incidence of IPS is 1 in 2300 to 5000 births. It is more likely to occur in the perinatal period than at any time in childhood. Long-term neurologic morbidity is common. Risk factors are not well defined and are unreliable. An agenda for future research is proposed.