Epilepsy in children with perinatal arterial ischemic stroke

Purpose: Perinatal ischemic stroke (PIS) is a frequent cause for perinatal brain structure defects resulting in epilepsy, cerebral palsy and disability. Since the severity of symptoms is variable, the aim of this study was to evaluate the outcome of children with PIS and seizures/epilepsy to aid parental counseling and therapy decisions. Material: We studied retrospectively patients with arterial PIS and structural epilepsy or seizures in the newborn treated at a single center in 2000-2019. Specifically, signs and symptoms of cerebral palsy (CP), developmental and motor delay, epilepsy and thrombophilia were assessed. Results: From the identified 69 individuals with arterial PIS, we only included the 50 patients (64% male) who had structural epilepsy at the time of investigation or previously in their medical history.The mean age of the included patients was 7.1 years (range 0.08-22) at last consultation. Infarct localisation was predominantly unilateral (86%), left sided (58%) and affecting the middle cerebral artery (94%). Genetic thrombophilia was identified in 52% of the patients examined with genetic testing. More than half of the individuals had CP (52%), and 38.5% had a cognitive outcome below average. First seizures occurred in the neonatal period in 58% of patients and developed into drug-refractory epilepsy in 24.1%. Children with late-onset of epilepsy were twice as likely to develop drug-refractory epilepsy (52.4%). Discussion: Our study shows that patients with PIS and seizures as common sequela often also develop CP. Children with later onset of epilepsy have a worse outcome. Patients with seizure onset in the neonatal period and reccuring seizures have a good response to treatment. Therefore, early diagnosis, follow-up examination and adequate therapy are important. Most children need intensive physiotherapy and speech therapy; however, participation in life is usually age-appropriate.

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Cerebral Palsy After Perinatal Arterial Ischemic Stroke

Journal of Child Neurology ◽

10.1177/0883073807309246 ◽

2008 ◽

Vol 23 (3) ◽

pp. 279-286 ◽

Cited By ~ 63

Author(s):

Meredith R. Golomb ◽

Bhuwan P. Garg ◽

Chandan Saha ◽

Faouzi Azzouz ◽

Linda S. Williams

Keyword(s):

Cerebral Palsy ◽

Ischemic Stroke ◽

Arterial Ischemic Stroke ◽

Perinatal Arterial Ischemic Stroke

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Does Diffusion Tensor Imaging-Based Tractography at 3 Months of Age Contribute to the Prediction of Motor Outcome After Perinatal Arterial Ischemic Stroke?

Stroke ◽

10.1161/strokeaha.111.624858 ◽

2011 ◽

Vol 42 (12) ◽

pp. 3410-3414 ◽

Cited By ~ 42

Author(s):

Niek E. van der Aa ◽

Alexander Leemans ◽

Frances J. Northington ◽

Henrica L. van Straaten ◽

Ingrid C. van Haastert ◽

...

Keyword(s):

Ischemic Stroke ◽

Diffusion Tensor Imaging ◽

Positive Predictive Value ◽

Predictive Value ◽

Neonatal Period ◽

Motor Behavior ◽

Diffusion Tensor ◽

Motor Deficits ◽

Arterial Ischemic Stroke ◽

Perinatal Arterial Ischemic Stroke

Background and Purpose— After perinatal arterial ischemic stroke, diffusion-weighted imaging (DWI) and early evaluation of spontaneous motor behavior can be used to predict the development of unilateral motor deficits. The aim of this study was to investigate whether diffusion tensor imaging-based tractography at 3 months of age contributes to this prediction. Methods— Twenty-two infants with unilateral perinatal arterial ischemic stroke were included and scanned during the neonatal period. DWI was used to assess restricted diffusion in the cerebral peduncle. At the age of 3 months, diffusion tensor imaging-based tractography of the corticospinal tracts was performed along with assessment of the movement repertoire. The role of DWI, diffusion tensor imaging, and motor assessment in predicting unilateral motor deficits were compared by calculating the positive and negative predictive values for each assessment. Results— Eleven infants (50%) showed abnormal motor behavior at 3 months with subsequent development of unilateral motor deficits in 8 as determined at follow-up (9–48 months, positive predictive value 73%). Diffusion tensor imaging-based tractography correctly predicted the development of unilateral motor deficits in all 8 infants (positive predictive value 100%). A diagnostic neonatal DWI was available in 20 of 22 (91%) infants. Seven infants showed an abnormal DWI, resulting in unilateral motor deficits in 6 infants (positive predictive value 86%). All assessments had a negative predictive value of 100%. Conclusions— Diffusion tensor imaging-based tractography at 3 months can be used to predict neurodevelopmental outcome after perinatal arterial ischemic stroke. It has a similar predictive value as DWI in the neonatal period and can especially be of additional value in case of an indecisive neonatal DWI or unexpected abnormal early motor development.

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Impact of Age at Pediatric Stroke on Long-term Cognitive Outcome

Neurology ◽

10.1212/wnl.0000000000013207 ◽

2021 ◽

pp. 10.1212/WNL.0000000000013207

Author(s):

Stephanie Abgottspon ◽

Qendresa Thaqi ◽

Leonie Steiner ◽

Nedelina Slavova ◽

Sebastian Grunt ◽

...

Keyword(s):

Early Childhood ◽

Ischemic Stroke ◽

Processing Speed ◽

Lesion Size ◽

Cognitive Outcome ◽

Late Childhood ◽

Control Group ◽

Childhood Stroke ◽

Arterial Ischemic Stroke

Objectives:To investigate the impact of age at pediatric arterial ischemic stroke on long-term cognitive outcome in order to identify patients particularly at risk for the development of cognitive long-term cognitive sequelae.Methods:This cross-sectional study included patients in the chronic phase of stroke (> 2 years after stroke) previously diagnosed with neonatal or childhood arterial ischemic stroke and a control group. Participants with active epilepsy, severe learning difficulties, or behavioral problems hindering the cognitive assessment were excluded. Several cognitive domains, including intelligence, executive functions (working memory, inhibition, and cognitive flexibility), processing speed, memory, letter fluency, and visual-motor skills were assessed with neuropsychological tests. Cognitive long-term outcome was compared across patients after neonatal stroke (stroke between 0 and 28 days of life), early childhood stroke (stroke between 29 days and < 6 years) and late childhood stroke (stroke between ≥ 6 and < 16 years).Results:52 patients after neonatal or childhood arterial ischemic stroke (median age: 15.3 years, IQR = 10.6 – 18.7) and 49 healthy controls (median age: 13.6 years, IQR = 9.8 – 17.2) met the inclusion criteria. Cognitive outcome was significantly worse in the pediatric stroke group compared to the control group. A non-linear effect of age at stroke (irrespective of lesion size and lesion location) was found for cognitive flexibility, processing speed, and verbal learning with early childhood stroke (29 days to < 6 years) showing significantly worse cognitive outcome compared to neonatal or late childhood stroke (p < .05, FDR-corrected).Conclusion:Age at stroke is an important factor for post-stroke recovery and modulates long-term cognitive outcome irrespective of lesion size and lesion location. Children after early childhood stroke are at particular risk for alterations of long-term cognitive functions.

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66 Long-term survival and neurodevelopmental outcomes of very-preterm infants born in Canada between 2009 and 2016

Paediatrics & Child Health ◽

10.1093/pch/pxab061.051 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e46-e47

Author(s):

M Florencia Ricci ◽

Prakesh Shah ◽

Diane Moddemann ◽

Ruben Alvaro ◽

Eugene Ng ◽

...

Keyword(s):

Cerebral Palsy ◽

Hearing Impairment ◽

Late Onset ◽

Cognitive Outcome ◽

Neurodevelopmental Outcomes ◽

Perinatal Medicine ◽

Term Survival ◽

Extremely Preterm ◽

Neurodevelopmental Impairment ◽

Improvement Programs

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Quality improvement programs across Canadian Neonatal Network (CNN) sites have led to increased neonatal survival without major neonatal morbidity among infants born extremely preterm. The next step is to determine if such activities impact longer-term survival and neurodevelopmental outcomes. Objectives This cohort study aimed to compare death or significant neurodevelopmental impairment (sNDI) (Bayley-III scores < 70, severe cerebral palsy, blind, or hearing aided) at 18-24 months corrected age among infants born < 29 weeks’ gestation admitted to CNN sites, between 2 Epochs: 1 (2009-2012) and 2 (2013-2016). Secondary objectives included death or neurodevelopmental impairment (NDI) (Bayley-III < 85, any cerebral palsy, visual or hearing impairment), death, sNDI, NDI, and components of neurodevelopmental impairment. Design/Methods Only sites with ≥ 70% follow-up rates were included. Differences in maternal-infant characteristics and neonatal morbidities were assessed by Pearson Chi-square and Student t-test testing. Adjusted odds ratios with 95% CIs were calculated for outcome change between the 2 Epochs, accounting for patient characteristic differences in the model. Results Study population included 4426 children; Epoch 1: 1895 (43%) and Epoch 2: 2531 (57%). In Epoch 2, more mothers received MgSO4 (56.3% vs. 28.4%; p<0.01), antibiotics (69%vs.65.3%; p 0.01) and delayed cord clamping (37.1% vs. 31.3%; p 0.02), and fewer infants had SNAP-2 (illness severity score) >20 (30.7% vs. 35.2%; p<0.01) or late-onset sepsis (23.3% vs. 26.9%; p 0.01). See Table 1. Conclusion Significant reductions in rate of death or sNDI, and in visual and hearing impairment, were identified between Epoch 2 to Epoch 1. An increase in poor cognitive outcome rates requires further study.

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Early-Onset Seizures Are Correlated With Late-Onset Seizures in Children With Arterial Ischemic Stroke

Stroke ◽

10.1161/strokeaha.113.004015 ◽

2014 ◽

Vol 45 (4) ◽

pp. 1161-1163 ◽

Cited By ~ 25

Author(s):

Chen-Jui Hsu ◽

Wen-Chin Weng ◽

Steven Shinn-Feng Peng ◽

Wang-Tso Lee

Keyword(s):

Ischemic Stroke ◽

Early Onset ◽

Late Onset ◽

Arterial Ischemic Stroke

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First Autologous Cord Blood Therapy for Pediatric Ischemic Stroke and Cerebral Palsy Caused by Cephalic Molding during Birth: Individual Treatment with Mononuclear Cells

Case Reports in Transplantation ◽

10.1155/2016/1717426 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

A. Jensen ◽

E. Hamelmann

Keyword(s):

Cerebral Palsy ◽

Ischemic Stroke ◽

Cord Blood ◽

Brain Damage ◽

Mononuclear Cells ◽

Cord Blood Transplantation ◽

Rare Event ◽

Treatment Modalities ◽

Individual Treatment ◽

Arterial Ischemic Stroke

Intracranial laceration due to traumatic birth injury is an extremely rare event affecting approximately one newborn per a population of 4.5 million. However, depending on the mode of injury, the resulting brain damage may lead to lifelong sequelae, for example, cerebral palsy for which there is no cure at present. Here we report a rare case of neonatal arterial ischemic stroke and cerebral palsy caused by fetal traumatic molding and parietal depression of the head during delivery caused by functional cephalopelvic disproportion due to a “long pelvis.” This patient was treated by autologous cord blood mononuclear cells (45.8 mL, cryopreserved, TNC2.53×10e8) with a remarkable recovery. Active rehabilitation was provided weekly. Follow-up examinations were at 3, 18, 34, and 57 months. Generous use of neonatal head MRI in case of molding, craniofacial deformity, and a sentinel event during parturition is advocated to enhance diagnosis of neonatal brain damage as a basis for fast and potentially causative treatment modalities including autologous cord blood transplantation in a timely manner.

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Perinatal Arterial Ischaemic Stroke In Neonate

Journal of Bahria University Medical and Dental College ◽

10.51985/jbumdc2018027 ◽

2018 ◽

Vol 08 (02) ◽

pp. 123-125

Author(s):

Anila Haroon ◽

Shakeel Ahmed ◽

Syed Rehan Ali

Keyword(s):

Cerebral Palsy ◽

Ischemic Stroke ◽

Health Care Providers ◽

Developing World ◽

Perinatal Period ◽

Care Providers ◽

Arterial Ischemic Stroke ◽

Perinatal Stroke ◽

True Incidence ◽

Hemiplegic Cerebral Palsy

Arterial ischemic stroke (AIS) is not uncommon in neonates, but in large part of developing world it has been missed and remains undiagnosed because of lack of resources and insufficient engagement by health care providers. The incidence of ischemic perinatal stroke ranges between 1 in 200 No, to 1 in 5000 births and is reported to be responsible for 30% to 50% of congenital hemiplegic cerebral palsy (CP) who were born at term or late preterm gestations. The true incidence of AIS from the developing world is not known as neuroimaging facilities are available in few centers; most of these cases remain undiagnosed. Over the past decades, ischemic perinatal stroke has emerged as an important cause of brain injury in the perinatal period and remains a leading cause of cerebral palsy. We are reporting a 3 days old male baby who presented with refractory seizures, subsequently diagnosed as arterial ischemic stroke

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