A rterial ischemic stroke (AIS) is not uncommon in the pediatric population, with an incidence of 1.25 per 100 000 per year. Previous studies have reported that early-onset seizures are a common feature in children with AIS, 1-3 and ≈19% to 44% of children with AIS had early-onset seizures. Among adults, the incidence of early-onset seizures was between 2.4% and 5.4%, 4 which was much lower than the incidence in children. Also, in adults, most stroke patients with early-onset seizures do not

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... elop late-onset seizures or poststroke epilepsy. 5 Therefore, in this retrospective analysis, we aimed to evaluate the epidemiology of early-onset seizures after AIS in children, as well as to determine their relationship with late-onset seizures and the outcome in children. Methods Subjects We identified all children with strokes admitted to our department from the database. We enrolled only children with a first-ever and image-confirmed AIS in our study. AIS was defined as an acute focal neurological syndrome attributable to cerebral infarction in an arterial distribution. We excluded children with previous strokes and those without available image data. Clinical Features and Seizures Early-onset seizures were defined as seizures occurring <7 days after the stroke, and late-onset seizures were defined as unprovoked seizures occurring ≥7 days after the stroke. Poststroke epilepsy was defined by ≥2 unprovoked seizures noted after the acute stage of the stroke. Seizure types were categorized clinically, based on the criteria of the International League Against Epilepsy. Statistical Analysis We used Student t test to compare continuous variables and χ 2 statistic to compare categorical variables. We also used the Kaplan-Meier survival analysis for cumulative incidence of subsequent unprovoked seizures. The log-rank test was used to compare the risk of subsequent unprovoked seizures for children with and without early-onset seizures. Statistical significance was considered when P<0.05. Results Study Population A total of 94 children with first-time and image-confirmed AIS were enrolled in this study. Eleven children (11.7%) died during hospitalization for AIS, and 5 children had seizures before AIS. Therefore, only 78 survivors were enrolled for the subsequent analysis. Early-Onset Seizures Early-onset seizures were observed in 20 of 78 survivors (25.6%; Table) . The mean onset age of early-onset seizures was 3.4±3.9 years, which was significantly younger compared with those without early-onset seizures (9.0±6.2 years; P<0.001). Eighteen of 20 children (90%) had early-onset seizures as initial presentation. Early-onset seizures were focal in 15 (75%) children. Three (15%) had generalized seizures, and 2 (10%) had secondary generalized seizures. Multiple Background and Purpose-Early-onset seizures are common in children with arterial ischemic stroke, but the clinical features and effects on the outcome of early-onset seizures have been less studied in children. Methods-Children aged 1 month to 18 years presenting with first-time and image-confirmed arterial ischemic stroke were identified for analysis. Results-A total of 78 survivors of arterial ischemic stroke were enrolled. Twenty (25.6%) had early-onset seizures, and 90% were initial presentation. Younger children (mean, 3.4±3.9 versus 9.0±6.2 years; P<0.001) and cortical involvement (5% versus 63.8%; P=0.01) are more likely to have early-onset seizures. Thirteen of 20 survivors with early-onset seizures had late-onset seizures after the acute stage, and 12 of them were diagnosed as poststroke epilepsy. Conclusions-Early-onset seizures occurred in 25.6% of children with arterial ischemic stroke. Younger age and cortical involvement were risk factors for early-onset seizures. Sixty-five percent of children with early-onset seizures had lateonset seizures after the acute stage. (Stroke. 2014;45:1161-1163.)