SE After Pediatric Stroke Tied to Poor Recovery

TOPLINEIn children with ischemic stroke, acute seizures (defined as those occurring within 7 days of stroke onset) were linked to an increased risk for poststroke epilepsy, particularly in those with status epilepticus (SE) or multiple seizures, a prospective cohort study showed. SE alone was also linked to poor functional outcomes, and both SE and multiple seizures were linked to a lack of functional improvement between 90 days and 1 year.METHODOLOGYResearchers analyzed data from CPISR, a prospective multicenter cohort study conducted in China from January 2022 to May 2024.A total of 562 children with ischemic stroke (median age, 7.2 years; 56.9% boys) were included.Researchers assessed functional outcomes at 90 days and 1 year using Pediatric Stroke Outcome Measure scores, as well as functional improvement from 90 days to 1 year, all-cause mortality, and the development of poststroke epilepsy.Potential associations between acute seizure patterns (SE, short seizures, single seizure, and multiple seizures) and outcomes were examined, along with the role of prophylactic and early use of antiseizure medication (ASM).The fully adjusted model controlled for age, sex, Pediatric National Institutes of Health Stroke Scale score at admission, cortical involvement, stroke risk factors, antithrombotic therapy, and center.TAKEAWAYA total of 137 children had acute seizures after ischemic stroke (30 had SE and 107 had short seizures; 69 had a single seizure and 68 had multiple seizures). In the fully adjusted model, acute SE was associated with poor functional outcome at 1 year (adjusted odds ratio [aOR], 6.29; 95% CI, 2.10-19.09).In the fully adjusted model, acute SE (aOR, 2.90; 95% CI, 1.08-9.26) and multiple seizures (aOR, 2.33; 95% CI, 1.11-5.17) were associated with no functional improvement between 90 days and 1 year.In the fully adjusted model, children with acute seizures had an increased risk for poststroke epilepsy (adjusted hazard ratio [aHR], 5.52; 95% CI, 2.63-11.58), with the highest risk observed in children with SE (aHR, 14.48; 95% CI, 5.77-36.34), followed by those with multiple seizures (aHR, 6.12; 95% CI, 2.56-14.65), single seizure (aHR, 4.19; 95% CI, 1.68-10.40), and short seizures (aHR, 3.01; 95% CI, 1.32-6.88), all compared with children without acute seizures.No significant association was observed between acute seizures and all-cause mortality after full adjustment. Prophylactic or early use of ASM was not significantly associated with outcomes.IN PRACTICE"Acute seizure patterns may help identify children who require closer neurologic follow-up, more vigilant surveillance for poststroke epilepsy, and earlier rehabilitation planning after pediatric ischemic stroke," the authors wrote.SOURCEThe study was led by Yiran Dong, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China. It was published online on September 9 in the Journal of the American Heart Association.LIMITATIONSThe study was limited by non-standardized and potentially incomplete seizure detection, a short follow-up period, possibility of recall and ascertainment bias in remote seizure identification, and low power to examine clinically meaningful associations with mortality and prophylactic use of ASM. Additional limitations were the use of binary (rather than dose/duration-specific) ASM exposure data, lack of data on infarct size, cause of death, and long-term severity of epilepsy, lack of data on genetic or syndromic diagnoses, lack of correction for multiple comparisons, and the absence of molecular biomarkers.DISCLOSURESThe study was funded by the National Natural Science Foundation of China and the Natural Science Foundation of Anhui Province. The authors reported having no conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.