Investigators at Yale University School of Medicine, New Haven, CT; Children's Hospital of Philadelphia; Vanderbilt University, Nashville, TN; and Johns Hopkins University, studied the incidence and risk factors for seizures and epilepsy in 73 children with spontaneous intracerebral hemorrhage (ICH) including 20 perinatal subjects (>37 weeks gestation to 28 days) and 53 aged >28 days to <18 years at presentation. Acute symptomatic seizures occurred in 35 subjects (48%); they were a presenting symptom of ICH in 12 perinatal (60%) and 19 childhood (36%) subjects, and they occurred afterpresentation in 7. Electroencephalographic-only seizures occurred in 9 of 32 subjects (28%) with continuous EEG monitoring. One-year and 2-year remote symptomatic seizure-free survival rates were 82% and 67%, respectively. One-year and two-year epilepsy-free survival rates were 96% and 87%, respectively. Elevated intracranial pressure requiring acute intervention was a risk factor for seizures after presentation (P=0.01), for remote symptomatic seizures (P=0.03), and epilepsy (P=0.04). Single remote symptomatic seizures occur in many, and epilepsy is estimated to develop in 13% patients at 2 years after ICH presentation. [1]

COMMENT. Acute symptomatic seizures were defined as those occurring up to 7 days after the incident ICH, and remote symptomatic seizures as occurring beyond 7 days from ICH presentation. An editorial points out that acute symptomatic seizures with ICH occur more frequently in children (60%) than in adult reports (7%-31%). [2]

Hemisphere specific motor control mechanisms in post-stroke rehabilitation

Left hemisphere damage is associated with greater errors in movement direction of the contralateral limb while errors in movement extent are greatest after right hemisphere damage. The differential deficits induced by right or left hemisphere lesions must be considered during post-stroke rehabilitation. [3]