Navigating pediatric post-stroke epilepsy: comparative assessment of treatment strategies.

IF 2.1 4区 医学 Q3 CLINICAL NEUROLOGY
Çağatay Günay, Semra Hız Kurul, Uluç Yiş, Adem Aydın, Ayşe İpek Polat
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引用次数: 0

Abstract

Background: Although post-stroke epilepsy (PSE) is a prevalent complication in children, optimal management remains challenging. This study evaluated the impact of different treatment modalities and antiseizure medications (ASM) on the development and management of pediatric PSE following arterial ischemic stroke.

Methods: We conducted a retrospective cohort analysis over 20 years, examining pediatric patients who experienced seizures during the course of arterial ischemic stroke. Exclusions included neonatal stroke, hemorrhagic stroke, and sinovenous thrombosis. Cut-off point of seven days were accepted as early seizures and PSE. Treatments included acute stroke therapies such as intravenous tissue plasminogen activator, mechanical thrombectomy, anti-edema therapies, and antithrombotic treatments. Medications for seizure control were categorized as acute seizure management agents (benzodiazepines and phenytoin), which are not used for long-term post-stroke epilepsy control, and long-term antiseizure medications (levetiracetam and carbamazepine) for PSE management.

Results: Among 153 patients, 99 were male, with a median age of 23 months. PSE was diagnosed in 59.5% of the cohort. Cardiac disorders were the primary etiology (32.7%). Hyperacute treatments and anti-edema therapies showed no significant impact on PSE development. Benzodiazepines and phenytoin also did not affect PSE rates. Levetiracetam was associated with a higher PSE rate (66.7%) compared to carbamazepine (45.1%) (p = 0.010). Carbamazepine demonstrated superior seizure freedom at 6 and 24 months (p = 0.024 and p = 0.014, respectively). Seizure control was achieved in 19.8% of PSE patients through dose titration, with carbamazepine showing higher efficacy (p = 0.037). ASM discontinuation rates were higher with carbamazepine (95.7%) compared to levetiracetam (79.4%).

Conclusion: Acute stroke therapies, anti-edema, and antithrombotic treatments did not lower the PSE development. Benzodiazepines and phenytoin were not effective in preventing PSE. Carbamazepine may be more effective than levetiracetam in managing pediatric PSE, providing better seizure control and higher ASM discontinuation rates. Further research is needed to confirm these findings.

导航小儿卒中后癫痫:治疗策略的比较评估。
背景:虽然脑卒中后癫痫(PSE)是儿童常见的并发症,但最佳治疗仍然具有挑战性。本研究评估了不同的治疗方式和抗癫痫药物(ASM)对儿童动脉缺血性卒中后PSE的发展和管理的影响。方法:我们进行了20多年的回顾性队列分析,检查了在动脉缺血性脑卒中过程中发生癫痫发作的儿科患者。排除包括新生儿中风、出血性中风和静脉血栓形成。截点为7天为早期癫痫发作和PSE。治疗包括急性中风治疗,如静脉组织纤溶酶原激活剂,机械取栓,抗水肿治疗和抗血栓治疗。癫痫发作控制药物分为急性发作管理药物(苯二氮卓类药物和苯妥英)和长期抗癫痫药物(左乙拉西坦和卡马西平),前者不用于卒中后癫痫的长期控制,后者用于PSE管理。结果153例患者中,男性99例,中位年龄23个月。59.5%的患者被诊断为PSE。心脏疾病为主要病因(32.7%)。超急性治疗和抗水肿治疗对PSE的发展无显著影响。苯二氮卓类药物和苯妥英也不影响PSE发生率。左乙拉西坦的PSE发生率(66.7%)高于卡马西平(45.1%)(p = 0.010)。卡马西平在6个月和24个月时表现出更好的癫痫发作自由(p = 0.024和p = 0.014)。通过剂量滴定法,19.8%的PSE患者癫痫发作得到控制,卡马西平效果更好(p = 0.037)。卡马西平的ASM停药率(95.7%)高于左乙拉西坦(79.4%)。结论:急性脑卒中治疗、抗水肿和抗血栓治疗并没有降低PSE的发展。苯二氮卓类药物和苯妥英均不能有效预防PSE。卡马西平可能比左乙拉西坦更有效地治疗小儿PSE,提供更好的癫痫发作控制和更高的ASM停药率。需要进一步的研究来证实这些发现。
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来源期刊
Acta neurologica Belgica
Acta neurologica Belgica 医学-临床神经学
CiteScore
4.20
自引率
3.70%
发文量
300
审稿时长
6-12 weeks
期刊介绍: Peer-reviewed and published quarterly, Acta Neurologica Belgicapresents original articles in the clinical and basic neurosciences, and also reports the proceedings and the abstracts of the scientific meetings of the different partner societies. The contents include commentaries, editorials, review articles, case reports, neuro-images of interest, book reviews and letters to the editor. Acta Neurologica Belgica is the official journal of the following national societies: Belgian Neurological Society Belgian Society for Neuroscience Belgian Society of Clinical Neurophysiology Belgian Pediatric Neurology Society Belgian Study Group of Multiple Sclerosis Belgian Stroke Council Belgian Headache Society Belgian Study Group of Neuropathology
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