Abstract TMP99: Pediatric Intracerebral Hemorrhage: Acute Symptomatic Seizures and Epilepsy

Abstract

Background and Objectives: We aimed to define the incidence of acute symptomatic seizures and of remote symptomatic seizures and epilepsy after spontaneous pediatric intracerebral hemorrhage (ICH). Methods: Pediatric patients with spontaneous ICH presenting between 2007 and 2012 at three tertiary care centers were prospectively identified. Acute symptomatic seizures were defined as seizures occurring from presentation to 7 days after ICH. Survival analysis was used to assess development of a first remote symptomatic seizure and epilepsy (2 or more unprovoked seizures >7 days after ICH). Log-rank tests were used to examine putative risk factors for development of remote symptomatic seizures and epilepsy. Results: Seventy-three pediatric subjects with spontaneous ICH were identified, including 20 perinatal (≥37 weeks gestation to 28 days) and 53 childhood subjects (>28 days to <18 years). Acute symptomatic seizures occurred in 12 (60%) perinatal and 23 (43%) childhood subjects, p=.29, Fisher’s exact. Median age of childhood subjects with acute symptomatic seizures was younger than those without (2.2 versus 10.8 years, p=.006, rank-sum). Electrographic-only seizures occurred in 28% of 32 subjects who had continuous EEG monitoring. Follow-up was not different between perinatal and childhood subjects (median 371 versus 340 days), p=.68, rank-sum. One and two-year remote symptomatic seizure-free survival were 82% (95% CI 68-91%) and 67% (95% CI 46-82%). One and two-year epilepsy-free survival were 96% (95% CI 83-99%) and 87% (95% CI 65-95%). Elevated intracranial pressure (ICP) requiring urgent intervention was a risk factor for remote symptomatic seizures and epilepsy (p=.024 and p=.037, log-rank test). Conclusions: Acute symptomatic seizures are common in both perinatal and childhood ICH. Continuous EEG monitoring may identify electrographic-only seizures in some subjects. By two-years after ICH it is estimated that about one-third of patients will have a single remote symptomatic seizures and that about 13% will develop epilepsy. Elevated ICP requiring intervention is a risk factor for remote symptomatic seizures and epilepsy.