Acute status epilepticus and multiple seizures after pediatric ischemic stroke were associated with poorer recovery and higher risk of poststroke epilepsy, supporting risk stratification and targeted follow-up.
Key Findings
Results
Status epilepticus after pediatric ischemic stroke was associated with poor 1-year functional outcome.
Adjusted odds ratio for poor 1-year functional outcome with status epilepticus was 6.29 (95% CI, 2.10–19.09)
Status epilepticus was also associated with higher odds of no functional improvement (adjusted OR, 2.90 [95% CI, 1.08–9.26])
Among 562 children analyzed, 30 had status epilepticus
Outcomes were measured using the Pediatric Stroke Outcome Measure at 90 days and 1 year
Associations were observed in fully adjusted models
Results
Multiple acute seizures after pediatric ischemic stroke were associated with no functional improvement.
Adjusted OR for no functional improvement with multiple seizures was 2.33 (95% CI, 1.11–5.17)
68 of the 137 children with acute seizures had multiple seizures
This association was found in fully adjusted models
Multiple seizures did not show a statistically significant independent association with poor 1-year functional outcome beyond functional improvement outcomes
Results
Acute seizures were associated with worse Pediatric Stroke Outcome Measure subdomain scores at both 90 days and 1 year.
This finding was noted in exploratory analyses of subdomain scores
Associations were observed at both the 90-day and 1-year time points
137 of 562 children experienced acute seizures
Specific subdomain scores were assessed as part of the Pediatric Stroke Outcome Measure
Results
Acute seizures were not independently associated with all-cause mortality after full adjustment.
No independent association with all-cause mortality was observed after full adjustment
This was assessed in exploratory analyses
The cohort included 562 children from the Chinese Pediatric Ischemic Stroke Registry (CPISR)
Enrollment spanned January 2022 to May 2024 across multiple centers
Results
Acute seizures were associated with a substantially increased risk of poststroke epilepsy.
Adjusted hazard ratio for poststroke epilepsy associated with acute seizures was 5.52 (95% CI, 2.63–11.58)
The risk was particularly elevated in children presenting with status epilepticus or multiple seizures
Poststroke epilepsy was one of the primary outcomes tracked
The prospective multicenter design of the CPISR registry provided the data for this analysis
Results
Prophylactic and early antiseizure medication use were not significantly associated with clinical outcomes.
Neither prophylactic antiseizure medication use nor early antiseizure medication use showed significant associations with any of the measured outcomes
Antiseizure medication exposure was one of the primary exposures analyzed alongside acute seizures
Outcomes examined included functional outcome, functional improvement, mortality, and poststroke epilepsy
The role of antiseizure medications was described as 'uncertain' prior to this study, particularly in Chinese cohorts
Methods
The study enrolled 562 children aged 29 days to 18 years with ischemic stroke from a prospective multicenter Chinese registry.
Data came from the CPISR (Chinese Pediatric Ischemic Stroke Registry)
Enrollment period was January 2022 to May 2024
137 of 562 children (approximately 24%) had acute seizures
The registry is registered at chictr.org.cn with identifier ChiCTR2200059915
The study design was prospective and multicenter
What This Means
This research examined what happens to children who have seizures shortly after experiencing a stroke. Using data from a large Chinese registry of 562 children (ages 1 month to 18 years) who had ischemic strokes between 2022 and 2024, the researchers looked at whether the type and severity of early post-stroke seizures were linked to how well children recovered, whether they died, and whether they later developed epilepsy. About one in four children in the study had acute seizures after their stroke, including some with prolonged seizures (status epilepticus) and some with multiple seizures.
The study found that children who had status epilepticus — a severe, prolonged type of seizure — were more than six times as likely to have a poor outcome one year after their stroke compared to children without such seizures. Children who had multiple seizures were also more than twice as likely to show no functional improvement. Importantly, children who had any acute seizures were more than five times more likely to go on to develop epilepsy (recurring seizures) later on. However, the use of preventive or early antiseizure medications did not appear to significantly improve any of these outcomes.
This research suggests that the pattern of early seizures after a pediatric stroke — particularly whether a child has prolonged or multiple seizures — can help identify which children are at highest risk for poor recovery and future epilepsy. This information could be used to guide closer monitoring and follow-up care for the highest-risk children. The finding that antiseizure medications did not clearly improve outcomes highlights the need for further research into how best to manage seizures in this population.
Dong Y, Zhu B, Zhang W, Zhong J, Liu X, Sun W. (2026). Associations of Acute Seizure Patterns With Functional Outcomes, Mortality, and Remote Seizures After Pediatric Ischemic Stroke.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.049931