Teja Sebastian1, Isabella Strozzi2, Lori Xu3, Fiza Laheji1, Wilmot Bonnet4, Michael Dowling1, Rana Said5
1University of Texas Southwestern, 2Children's Medical Center, 3Children's Medical Center - Specialty Center, 4University of Texas SW Medical School, Child Neurology, 5UT Southwestern Medical Center
Objective:
- Characterize neonatal factors associated with increased epilepsy/infantile spasms risk in patients with perinatal strokes and response to treatment
Background:
Infantile spasms often present secondary to stroke in neonates and have been linked to high rates of drug-resistant epilepsy.Perinatal arterial ischemic stroke and perinatal hemorrhagic stroke have been found to have different maternal and fetal risk factors and therefore may have differences in clinical outcomes as well.
Identifying the subsets of patients with infantile spasms in perinatal stroke, associated risk factors and response to treatment will help guide management in the future
Design/Methods:
Data was collected using a retrospective chart review of the Children’s Medical Center EMR. Inclusion criteria:stroke occurring in the perinatal period,new-onset infantile spasms between 3 to 18 months of age and an EEG with hypsarrhythmia or modified hypsarrhythmia
Results:
- 31 were included in the study, of which 14(45%) were diagnosed with ischemic stroke and 17(55%) were diagnosed with hemorrhagic stroke with no significant difference in epilepsy outcomes (p=0.354).Males were more likely to be on a higher number of epilepsy medications (p=0.026).
- Female patients were 14 times more likely to be part of the response group (p=0.096).Caesarian section delivery patients were 7 times more likely to be part of the responder group (p=0.045)
- No hypsarrhythmia on initial EEG, male sex, and non- premature birth status taken together were found to be predictive of the number of epilepsy medications the patient was taking at follow-up therefore indicative of disease burden
Conclusions:
This study found sex differences in the response to treatment of infantile spasms as well as epilepsy. This warrants future study into whether different sexes may benefit from different treatment regimens. A future application of the findings includes creating an assessment for the probability of developing medically refractory epilepsy later in life based on patient and treatment factors