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.

中文翻译：

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新生儿和儿童脑静脉血栓形成一年后的癫痫发作和结果。

背景

小儿脑静脉血栓形成是脑损伤、急性症状性癫痫发作和远期癫痫的可治疗原因。我们的目的是前瞻性研究脑静脉血栓形成诊断一年后新生儿和儿童的癫痫及其结局。

方法

通过小儿卒中癫痫研究前瞻性地招募了来自 21 个国际地点的脑静脉血栓形成患者。诊断时收集临床数据，包括急性症状性癫痫发作和脑静脉血栓形成危险因素。一位不知道诊断的神经放射科医生检查了急性影像学。一年时，收集的结果包括癫痫复发、癫痫诊断、抗癫痫药物使用和改良恩格尔评分。使用改良的兰金评分和儿童头部损伤国王结果量表评估结果。

结果

24 名患有脑静脉血栓形成的参与者入组（67% 为男性，21% 为新生儿）。头痛是非新生儿中最常见的症状（47%，19 人中有 9 人）。九人（37.5%）出现急性症状性癫痫发作。一年随访后，六名患者（25%；95% 置信区间，10% 至 47%）患上癫痫。没有发现与癫痫相关的临床预测因素。国王儿童期头部受伤结果量表和一年后修改后的 Rankin 评分对 71% 的人来说是有利的。一半的癫痫患者（六分之三）在急性住院期间没有发现梗塞、出血或癫痫发作。

结论

我们的研究提供了一项前瞻性估计，大约四分之一的患者在诊断脑静脉血栓形成一年后会发生癫痫。在没有急性癫痫发作或与急性表现相关的实质损伤的情况下，可能会出现后来的癫痫。