Electrographic Seizures and Predictors of Epilepsy after Pediatric Arteriovenous Malformation Rupture

Authors

Julia S. Keenan, Division of Epilepsy and Neurophysiology, Children's National Hospital; Department of Neurology, Children's National Hospital.
Dana B. Harrar, Division of Epilepsy and Neurophysiology, Children's National Hospital; Department of Neurology, Children's National Hospital; Department of Neurology and Pediatrics, George Washington University.
Claire Har, Division of Epilepsy and Neurophysiology, Children's National Hospital; Department of Neurology, Children's National Hospital.
Caroline Conley, Department of Critical Care Medicine, Children's National Hospital.
Katelyn Staso, Department of Critical Care Medicine, Children's National Hospital.
Arnold J. Sansevere, Division of Epilepsy and Neurophysiology, Children's National Hospital; Department of Neurology, Children's National Hospital; Department of Neurology and Pediatrics, George Washington University. Electronic address: asansevere@childrensnational.org.

Document Type

Journal Article

Publication Date

9-27-2024

Journal

The Journal of pediatrics

DOI

10.1016/j.jpeds.2024.114325

Keywords

Arteriovenous malformation; ICU EEG; electroencephalography; electrographic seizures; epilepsy; pediatric intensive care; pediatric stroke; pediatrics

Abstract

OBJECTIVE: To assess clinical and electroencephalogram (EEG) predictors of epilepsy and to describe the percentage of electrographic seizures (ES) and development of epilepsy among patients with spontaneous intracerebral hemorrhage (ICH) due to arteriovenous malformation (AVM) rupture. STUDY DESIGN: Retrospective review of patients admitted to the pediatric intensive care unit with ICH secondary to AVM rupture over 11 years. Clinical variables were collected by review of the electronic medical record. Seizures were described as acute symptomatic (7 days after AVM rupture), subacute (7-30 days after AVM rupture) and remote (greater than 30 days after AVM rupture). Outcome metrics included mortality, and the development of epilepsy post discharge. Descriptive statistics were used. RESULTS: Forty-three patients met inclusion criteria with a median age of 12.2 years (IQR 7.3-14.8) and 49% (21/43) were female. Sixteen percent (7/43) presented with a clinical seizure prior to EEG placement. EEG was performed in 62% (27/43) of patients; one had electrographic status epilepticus without clinical signs. Sixteen percent (7/43) of patients were diagnosed with epilepsy, with a median time to diagnosis of 1.34 years (IQR 0.55-2.07) after AVM rupture. One-year epilepsy free survival was 84% (95% CI 70%-98%) and two-year epilepsy free survival was 79% (95% CI 63%-95%) Remote seizures were associated with epilepsy (p<0.001), but acute symptomatic seizures were not (p=0.16). CONCLUSIONS: EEG-confirmed seizures are uncommon in patients with ICH secondary to AVM rupture; however when identified, the seizure burden appears to be high. Patients with seizures 30 days after AVM rupture are more likely to develop epilepsy.

APA Citation

Keenan, Julia S.; Harrar, Dana B.; Har, Claire; Conley, Caroline; Staso, Katelyn; and Sansevere, Arnold J., "Electrographic Seizures and Predictors of Epilepsy after Pediatric Arteriovenous Malformation Rupture" (2024). GW Authored Works. Paper 5575.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5575

Department

Neurology