Epilepsy in hemiplegic cerebral palsy due to perinatal arterial ischaemic stroke

Abstract

AIM The aim of this study was to describe the frequency, risk factors, manifestations, and outcome of epilepsy in children with hemiplegic cerebral palsy (CP) due to perinatal arterial ischaemic stroke (AIS). METHODThe study group comprised 63 participants (41 males, 22 females) from a populationbased CP register whose brain imaging showed perinatal AIS. Information collected included occurrence of neonatal seizures, family history of epilepsy, motor function and epilepsy onset, treatment, and outcome. Electroclinical findings were classified according to seizure semiology, seizure type, and epilepsy syndrome.RESULTS Mean age of participants at the time of study was 10 years 6 months (SD 4y 7mo, range 4-20y). Gross Motor Function Classification System levels I and II were reported in 96% of participants, and Manual Ability Classification System levels I and II were reported in 79% of children. Thirty-four children (54%) developed epilepsy. Term delivery and more severe motor impairment were associated with epilepsy, but neonatal seizures and family history of epilepsy were not. Initial seizures were epileptic spasms, focal seizures, or myoclonic seizures. Focal seizure semiology suggested Rolandic or occipital seizure origin in the majority of children. Focal epileptic discharges in children with focal seizures had features of idiopathic partial epilepsy. Only 15% of children had active epilepsy 10 years after onset.INTERPRETATION Despite a high incidence of epilepsy in children with hemiplegic CP due to AIS, the prognosis for seizure remission is good. Many children have clinical features, electroencephalography findings, and remission typical of idiopathic partial epilepsy.Epilepsy is a significant comorbidity in children with cerebral palsy (CP), potentially affecting cognitive development, mobility, and the ability to live independently. Estimates of the frequency depend on the pathology, the type of motor impairment, or both.1,2 Most studies have included multiple CP subtypes with diverse or uncertain aetiologies, and none has included detailed epilepsy evaluations with epilepsy syndrome classification. Little is known about risk factors and long-term outcome for specific epilepsy syndromes in a particular CP subtype.This study aimed to describe the epileptology in a group of young people with a common pathology and aetiology, namely children with hemiplegic CP resulting from perinatal arterial ischaemic stroke (AIS). We looked at risk factors, frequency and types of seizures, epilepsy syndromes, evolution of the epilepsy, and quality of life.

Life After Perinatal Stroke

“…5,37,44 Despite a unilateral lesion, infantile spasms and other epileptic encephalopathies can occur. Fortunately, many children eventually outgrow their epilepsy.…”

“…Fortunately, many children eventually outgrow their epilepsy. 44,45 Treatment studies specific to perinatal stroke have not been completed, although they may be excellent epilepsy surgery candidates. The treatment of acute neonatal seizures in perinatal stroke is unstudied, but importantly, continuous electroencephalogram (EEG) monitoring often detects subclinical seizures.…”

Neonatal seizures triple the risk of a remote seizure after perinatal ischemic stroke

“…In 54 children (62%), a physician diagnosis of cerebral palsy was recorded in the medical record. Children who presented with stroke during the neonatal period were more likely to have multiple infarcts (29% vs 3%, p 5 0.001), were younger when they began walking (median age of 13 [IQR 10-17] vs 16 [IQR [13][14][15][16][17][18][19][20][21][22] months, p 5 0.04), and were less likely to have a cerebral palsy diagnosis recorded (50% vs 85%, p 5 0.001) (table e-2). Otherwise, demographics, birth history, and years of follow-up were similar between the 2 groups.…”

“…4,5,16,17 Among children with delayed presentation of presumed perinatal ischemic stroke, estimates of epilepsy range from 38% to 55%. 18,19 The broad ranges reported across prior studies may be related to modest sample sizes, differences in study setting, varying definitions for epilepsy, or methods of outcome ascertainment.…”

Health-Related Quality of Life in Children and Adolescents with Epilepsy: A Systematic Review

“…One study reported that symptomatic epilepsy syndromes had lower levels of physical, psychological, and social compared to idiopathic epilepsy syndromes (Sabaz, 2003). Finally, two studies analyzed HRQOL in epilepsy in cerebral palsy and reported decreased levels of functioning and wellbeing in different domains (Wake et al, 2003;Wanigasinghe et al 2010). Finally, four studies reported that there was acceptable agreement between children/adolescents and parents, but parents tended to underestimate the HRQOL of their children (Miller et al, 2003;Van Empelen et al 2005;Yam et al, 2008;Verhey et al, 2009).…”