Epilepsy Derived from Neonatal Stroke Involving the Middle Cerebral Artery (MCA) : Clinical Presentation, Treatment and Outcome
Abstract number :
2.139
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2203996
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:22 AM
Authors :
Geum-ji Shin, MD – Severance Children's Hospital; Kyu Un Cho, MD – Fellow, Pediatric neurology, Severance Children's Hospital; Hoon-Chul Kang, MD, PhD – Professor, Pediatric neurology, Severance Children's Hospital; Heung Dong Kim, MD, PhD – Professor, Pediatric neurology, Severance Children's Hospital; Sae Hee Kim, MD, PhD – Professor, Pediatric neurology, Severance Children's Hospital; Joon Soo Lee, MD, PhD – Professor, Pediatric neurology, Severance Children's Hospital
Rationale: Neonatal stroke is an important cause of childhood epilepsy. Neonatal stroke is a cerebrovascular attack confirmed by neuroimaging. The most common location of arterial ischemic stroke is the middle cerebral artery (MCA). Neonatal cerebral infarctions result in sequelae such as motor deficits, epilepsy, cognitive impairment, and behavioral disorders. Especially, neonatal seizures nearly triple the risk of remote seizure. Sequelae such as epilepsy have significantly negative impacts on the quality of life as well as financial burden to the healthcare system. We investigated epilepsy cases caused by neonatal MCA infarctions and their clinical presentations, treatments and outcomes in Severance Children’s Hospital, Korea.
Methods: We retrospectively reviewed 22 patients on the Severance Children’s Hospital’s electronic medical record who were diagnosed with MCA infarction by neuro-sonography in neonatal period from 2013-2021 and report their clinical presentations, demographics, treatments, and outcomes.
Results: Twenty two patients (8 males, 14 females) were included in this study. The mean age of patients is 67 month and the median follow-up period is 26 (IQR, 1-166) month. All of the patients were diagnosed with MCA infarction at the neonatal period, mainly on the left side (18 patients, 82%). Seizures were the most common complication (18 patients, 82%). 14 patients (63.6%) had seizures in neonatal period, 4 patients after neonatal period. In 18 epilepsy patients, 5 (22.7%) have well-controlled seizures with anti-seizure medication (ASM), 3 patients (13.6%) had hemispherectomy, 1 patient (4.5%) had subduro-peritoneal shunt. 12 patients (54.5%) have no clinical seizure after neonatal period not taking ASM recently. One patient (4.5%) was lost to follow-up. ASM reduced the seizure frequencies in all patients and achieved reached seizure-free states in some. Three patients who had hemispherectomy have become seizure-free, though 2 patients required ASM.
Conclusions: This study suggest that ASMs decrease seizure events caused by neonatal stroke involving middle cerebral artery. Refractory epilepsy cases benefited from more invasive interventions such as functional hemispherectomy without notable complications.
Funding: This study was supported by the Team Science Award of Yonsei University College of Medicine (6-2021-0007) and a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HI21C1659), and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2022R1A2C1012522).
Clinical Epilepsy