Kevin O’Connor, M.D.

Sundelin HEK, Tomson T, Zelano J, Söderling J, Bang P, Ludvigsson JF. Pediatric Ischemic Stroke and Epilepsy: A Nationwide Cohort Study. Stroke. 2021.

Post-stroke epilepsy is a well-known entity, particularly in adults. To explore post-stroke epilepsy in children, Sundelin et al. used the Swedish National Registers to identify 1220 children with ischemic stroke (including cerebral venous sinus thrombosis, which could not be differentiated in the Register) and 12155 comparators between 1969-2016; they excluded patients with previously known epilepsy.

Of the 1220 children with ischemic stroke, 219 (18%) developed post-stroke epilepsy compared to 91 comparators (0.7%). The epilepsy risk was highest in the six months following stroke (HR, 119.4 [95% CI, 48.0–297.4]) and remained elevated even at 20 years post-stroke (HR, 7.9 [95% CI, 3.3–19.0]). The cumulative incidence of post-stroke epilepsy increased with longer follow-up periods: 11.9% at 5 years (95% CI, 10.1%–14.0%), 21.6% (95% CI, 19.0%–24.6%), and 26.4% at 30 years (95% CI, 23.0%–30.1%).

After excluding children born preterm or small for gestational age (known risk factors for stroke and epilepsy), 155 (17.3%) children with ischemic stroke developed epilepsy compared to 64 (0.7%) comparators. The risk of post-stroke epilepsy remained elevated overall (HR, 31.7 [95% CI, 22.6–44.4]) and when stratified for perinatal stroke (<28 days after birth; n=66, HR, 36.7 [95% CI, 21.2–63.4]) and older children (n=89, HR, 28.7 [95% CI, 18.7–44.2]). 

Among the siblings, parents, and offspring of individuals with childhood ischemic stroke, siblings and parents had an increased risk of epilepsy (HR, 1.64 [95% CI, 1.08–2.48]; and HR, 1.41 [95% CI, 1.01–1.98], respectively).

Childhood ischemic stroke increases the risk of developing epilepsy, particularly following perinatal stroke and within the first six months after the insult. Further study is needed to examine the relationship (if any) between stroke characteristics (e.g., size, location) and epilepsy.