Study: Stroke During Childhood May Raise Risk for Epilepsy

A study claims that 13% of children who had a stroke at a young age developed epilepsy later in life.

Infants and children who survive a bleeding stroke may be at increased risk for seizures and epilepsy, a new study finds.

Each year in the United States, about six and a half newborns and children out of every 100,000 suffer strokes. About half of the strokes are bleeding strokes, typically caused by the rupturing of weakened or malformed blood vessels.

In this study, researchers looked at 73 infants and children, ranging from newborns to 18 years old, who suffered bleeding in their brain tissue, a type of stroke called intracerebral hemorrhage.

About 60 percent of the newborns and 43 percent of the older children had visible seizures at the time of the stroke or within one week after the stroke. Of the 32 patients who had continuous brain monitoring, 28 percent had seizures that would otherwise have gone undetected.

The researchers plan to explore whether these subtle seizures are a risk factor for more seizures, epilepsy or other problems over the long-term, according to the study.

The findings were scheduled for presentation Thursday at the American Stroke Association's annual meeting in Honolulu. The study also will be published simultaneously in the journal JAMA Neurology.

The investigators also found that 13 percent of the patients developed epilepsy within two years, and that those who had elevated pressure in the brain that required medical or surgical treatment were more likely to have seizures and epilepsy later.

"Information on the risk for later seizures and epilepsy provides practitioners with concrete numbers that can be presented to families," study lead author Dr. Lauren Beslow, an instructor of pediatrics and neurology at Yale University, said in an American Heart Association news release.

"While an estimate of 13 percent may seem low at two years, the rate of epilepsy might be greater at later points," she added.

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What causes epilepsy in newborn babies?

Epilepsy in newborn babies

• What causes epilepsy in newborn babies?
• Types of seizures
• Diagnosis
• Treatment
• Outlook

What causes epilepsy in newborn babies?

There are many different causes of seizures in newborn babies and in the first six months of life. In very premature babies, the most common causes are a reduced blood and oxygen flow to the brain, and bleeding into the brain. Other causes include infections such as meningitis, low blood sugar or calcium, poor development of the brain and rarely, problems with the metabolism. In some cases, the seizures may be due to a faulty gene or chromosome. In other cases no cause can be found.

See also: What is epilepsy? 

Types of seizures

Seizures in newborn babies are often difficult to recognise. This is because the immature brain of a very young child is unable to produce the more obvious seizures that can be seen in older children. In a newborn baby seizures may be very subtle and consist simply of changes in breathing patterns, movements of the eyelids or lips or bicycling movements of the limbs. They may also consist of brief jerks or episodes of stiffening of the body and limbs. The jerks are called myoclonic or clonic seizures and the episodes of stiffening are called tonic seizures, or, sometimes, spasms.

More information about different types of seizures

Diagnosis

It is important that any baby who is suspected of having seizures is referred to a specialist, who may arrange for diagnostic tests. One of the most commonly performed tests is the electroencephalogram (EEG). While the EEG is not a conclusive test for epilepsy, it can be very useful in detecting subtle seizures, and can also provide information about specific seizure types. It is important that the EEG of a newborn baby is interpreted by someone who specialises in this age group. This is because the brainwave patterns and seizures are often very different to those in older children and adults. 

Treatment

There is a large range of anti-epileptic medication currently available and new ones continue to be developed. However, one of the older drugs, phenobarbital, seems to be particularly useful in treating seizures in babies; other drugs such as carbamazepine or phenytoin may also be effective. Ultimately, the choice of medication will depend on the child’s seizure type, the age when the epilepsy began, the cause of the epilepsy, if known, and the likely outcome of that particular type of epilepsy.

Outlook

Many parents become frustrated as they feel that doctors give them little information about how their child will develop and whether the epilepsy will ever go away. This frustration is understandable, but the lack of information may simply be due to the fact that the doctors themselves do not always know what will happen in the future.

One of the things parents may worry about is whether their child’s intellectual abilities will be affected by epilepsy. Many children with epilepsy will develop with the same range of intellectual abilities as children without the condition. However, where the epilepsy is caused by damage to the brain, this damage can, in some cases, also cause learning disabilities.

In the newborn period it is not always possible to predict what the outcome for each child will be. In some cases it is only when particular development milestones are reached, or not reached, that the doctors can try to predict what the future may hold for that child. Ultimately, the outlook for the future, both in terms of general development and future epilepsy, depends on the nature and, most importantly, on the underlying cause of the child’s epilepsy.

Epilepsy Action has fact sheets about some types of childhood epilepsy. Please contact the Epilepsy Helpline, freephone 0808 800 5050 (UK), orhelpline@epilepsy.org.uk

For the less common types of epilepsy the UK organisation Contact a Familymay be able to provide information on self-help groups for children with specific conditions.

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