Seizures and Outcome One Year After Neonatal and Childhood Cerebral Sinovenous Thrombosis

Pediatr Neurol. 2020 Apr;105:21-26. doi: 10.1016/j.pediatrneurol.2019.08.012. Epub 2019 Oct 18.

Abstract

Background: Pediatric cerebral sinovenous thrombosis is a treatable cause of brain injury, acute symptomatic seizures, and remote epilepsy. Our objective was to prospectively study epilepsy and outcomes in neonates and children one year after cerebral sinovenous thrombosis diagnosis.

Methods: Patients with cerebral sinovenous thrombosis were enrolled prospectively from 21 international sites through the Seizures in Pediatric Stroke Study. Clinical data, including acute symptomatic seizures and cerebral sinovenous thrombosis risk factors, were collected at diagnosis. A neuroradiologist who was unaware of the diagnosis reviewed acute imaging. At one year, outcomes including seizure recurrence, epilepsy diagnosis, antiepileptic drug use, and modified Engel score were collected. Outcomes were assessed using the modified Rankin score and the King's Outcome Scale for Childhood Head Injury.

Results: Twenty-four participants with cerebral sinovenous thrombosis were enrolled (67% male, 21% neonates). Headache was the most common presenting symptom in non-neonates (47%, nine of 19). Nine (37.5%) presented with acute symptomatic seizures. Six (25%; 95% confidence interval, 10% to 47%) developed epilepsy by one-year follow-up. No clinical predictors associated with epilepsy were identified. King's Outcome Scale for Childhood Head Injury and modified Rankin scores at one year were favorable in 71%. Half of the patients who developed epilepsy (three of six) did not have infarcts, hemorrhage, or seizures identified during the acute hospitalization.

Conclusion: Our study provides a prospective estimate that epilepsy occurs in approximately one-quarter of patients by one year after diagnosis of cerebral sinovenous thrombosis. Later epilepsy can develop in the absence of acute seizures or parenchymal injury associated with the acute presentation.

Keywords: Cerebral sinovenous thrombosis; Outcomes; Pediatric stroke; Seizures.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anticonvulsants / administration & dosage
  • Child
  • Child, Preschool
  • Epilepsy* / diagnosis
  • Epilepsy* / drug therapy
  • Epilepsy* / etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant, Newborn
  • Ischemic Stroke* / complications
  • Ischemic Stroke* / diagnosis
  • Ischemic Stroke* / therapy
  • Male
  • Outcome Assessment, Health Care*
  • Seizures* / diagnosis
  • Seizures* / drug therapy
  • Seizures* / etiology
  • Sinus Thrombosis, Intracranial* / complications
  • Sinus Thrombosis, Intracranial* / diagnosis
  • Sinus Thrombosis, Intracranial* / therapy

Substances

  • Anticonvulsants