LAUSR

Introduction: Seizures occur at a high frequency in acute arterial ischemic stroke (AIS) in children however there is very limited knowledge regarding the frequency of electrographic only seizures. Early data suggests that seizures may independently be associated with a poorer outcome in acute brain injury. Without EEG monitoring electrographic seizures will go undetected resulting in a lost opportunity for neuroprotection. The aim of our study was to determine the incidence and risk factors of clinical and electrographic seizures in pediatric AIS. Methods: A pilot prospective single center study was performed between July 2018 and July 2019. Patients between 1 month and 18 years of age were eligible. Video EEG monitoring commenced <10 days following stroke onset. A neurologist and a second independent blinded epileptologist reported the EEG’s. Assessments included the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score and the modified Alberta Stroke Program Early Computed Tomography Score (modASPECTS). Clinical management was at the discretion of the treating neurologist. A standardized follow-up assessment was performed at 3 months. Results: Of 11 patients who had AIS during the study period, 10 were recruited. Median age was 3.7 years (range 6 weeks -12 years). Mean EEG duration was 26.8 hours. Electrographic seizures occurred in 4 (40%) patients. Of these 4 patients, 2 had clinical seizures prior to EEG onset. In addition, 1 patient had a clinical seizure prior to EEG with no subsequent electrographic seizures seen. Of the 5 patients with seizures, 3 were less than 2 years of age. Overall electrographic seizure burden was high. Only 2 of 10 patients had no cortical infarction however 1 of these patients had electrographic seizures. In comparing the group with electrographic seizures to those without, there was no statistically significant difference in the modASPECTS (median 4.5 (IQR 4) vs. 4 (9), p = 0.9239) and PedNIHSS scores (5 (9.5) vs. 14 (17), p = 0.3425). Conclusion: This prospective study demonstrated a high frequency and burden of electrographic seizures in young children with AIS. A larger multi-center study is warranted to define risk factors and outcome determinants with potential for recommendation regarding interventions.