Abstracts

In daily clinical practice parents and the patients themselves want to know soon, what the long-term prognosis after a stroke is. Whether epilepsy develops after stroke or not very often plays a major role for the quality of life later-on. Most published data on risk factors for the development of epilepsy after stroke in childhood are from the pre-MRI-area. We were interested in the question to which extent modern neuroimaging will be able to estimate better the individual risk for the development of epilepsy in children who have suffered a stroke. 98 patients (46 female, 52 male; average age 7 7/12years, standard deviation 5,15) treated in our rehabilitation department after childhood stroke in the time between 1986 and 2003 were included in this study. Children suffering from perinatal or traumatic insults resembling stroke in childhood were excluded. 46 of our patients had an MRI which was examined focused on localization and extent of damage once more. The following variables were taken into account: type of damage (hemorrhage vs. ischemia), localization and extent of damage, age at damage, age at seizure-onset. Seizures occurring [le] 2 days after the stroke were labeled as [ldquo]early seizures[rdquo]; seizures occurring 2 days after the stroke and later-on were labeled as [ldquo]late onset seizures[rdquo]. Minimum-follow up was 2 years. N=25 (25,5%) of all the patients developed epilepsy. Onset of epilepsy occurred often within the first 2 years of life; N=10 (45,5%). N=15 (60%) of the patients who developed epilepsy had [ldquo]early seizures[rdquo]. There was no significant difference between the [ldquo]hemorrhage-group[rdquo] (27,7% epilepsy) and the group of patients with ischemia (23,5% epilepsy). 100% of the patients who developed epilepsy had cortical scars; 10 of 25 patients (40%) with cortical scars developed epilepsy. Patients with lesions restricted to basal ganglia or cerebellum did not develop epilepsy. The risk for the development of epilepsy was higher when the territories of 2 or more vessels were damaged. The over-all risk for the development of epilepsy after childhood stroke is around 25%. It is not surprising that epilepsy develops only in cases with cortical damage. However, not all patients with cortical scars develop epilepsy. In contrast to series dealing with stroke in adulthood, early seizures are a major risk-factor for epilepsy. There is no difference between hemorrhagic- vs. ischemic insults with respect to the development of epilepsy.