Clinical and radiographic findings in children (age range, 1 month to 18 years) with seizures after ischemic stroke between 1996 and 2006 were analyzed retrospectively at Chang Gung Children’s Hospital and University College of Medicine, Taoyuan, Taiwan. Of 94 with ischemic stroke, 39 (41%) developed seizures; of these, 33 (85%) were new onset seizures. Twenty-one (75%) of 28 with no previous history of seizures had early poststroke seizures (occurring within 7 days after stroke), and 7 had late poststroke seizures (beyond 1 week after stroke). Infection was the etiology in 52% of the early poststroke seizure group but in none of the late poststroke seizure group. Infections included meningitis (6), encephalitis (1), meningoencephalitis (3), and sepsis (5). Infarction in the anterior and middle cerebral artery distribution occurred in 62% of the early and 57% of late postseizure groups. Children who had initial focal neurological signs or focal abnormalities in the EEG were most susceptible to late onset poststroke seizures (100% vs 38.1%, P=0.007; and 85.7% vs 33.3%, P=0.029, respectively, comparing those with and without focal abnormalities). Epilepsy developed in 38% of early and 100% of late onset seizure groups. 
COMMENT. Children with ischemic stroke are susceptible to seizures, and most develop within 1 week after stroke. Infection is the most common etiology. Focal signs are risk factors for development of epilepsy after childhood stroke.