Epilepsy after ischemic perinatal stroke in term born children: neuroimaging predictors, clinical course and cognitive outcome

Abstract

Insult tekib umbes ühel juhul tuhande vastsündinu kohta, mis oma esinemissageduselt on teisel kohal võrreldes erinevate eaperioodidega. Perinataalne ehk sünnilähedases eaperioodis väljenduv insult võib tekkida erinevate aju veresoonte ummistuse tõttu ja selle tagajärjel kujunev ajukahjustus on erinev ja enamasti elukestev. Kõige sagedamini esineb ühe kehapoole halvatust, kõne hilistumist, õpiraskusi ja epilepsiat. Jääknähud on sageli kombineerunud, mis halvendab nii laste kui nende perede elukvaliteeti. Siiski pole siiani selge, millise insuldist põhjustatud kahjustuse korral on lapsed rohkem ohustatud epilepsiast ning kas epilepsiaga laste kognitiivne ehk vaimne ja tunnetuslik areng on samasugune kui neil lastel, kellel insuldi järgselt epilepsiat ei teki. Doktoritöö eesmärgiks oli uurida epilepsia tekkimist perinataalse insuldi järgselt, et esmalt tuvastada ajukahjustuse tunnused, mis on seotud epilepsia kujunemise ja kuluga ning teiseks uurida, kas epilepsiaga laste kognitiivne areng erineb ilma epilepsiata laste omast. Uuringu tulemused näitasid, et erinevat tüüpi insuldi korral on epilepsia tekke risk, aeg ja kulg erinevad. Kõige kõrgem on epilepsia risk lastel, kellel esines keskmise ajuarteri sulgusest tingitud suur insult, ning neil võib epilepsia tekkida ka noorukieas, kuigi suurel osal insuldi juhtudest tekib epilepsia juba eelkoolieas. Epilepsiaga lastel esineb iseloomuliku mustriga ajuosade kahjustus, millist ilma epilepsiata lastel insuldi järgselt ei ole leitud. Paljudel juhtudel oli epilepsia kulg haiguse alguses raske, kuid lapseea lõpuks olid kolmveerand lastest epilepsia hoogudest vabad ning pooled epilepsiaga lastest ei vajanud enam ka epilepsiavastast ravi. Üldine kognitiivne areng oli epilepsiaga lastel halvem kui ilma epilepsiata lastel. Samas näitas spetsiifiliste alatestide uuring, et mitmete ülesannetega said epilepsiaga lapsed sama hästi hakkama kui ilma epilepsiata lapsed. Kokkuvõtvalt andsid uuringu tulemused teadmise, et epilepsia tekke riski, aega ja kulgu insuldi järgselt on võimalik ennustada ajukahjustuse iseloomu järgi magnetresonantstomograafilisel uuringul ning uurides laste kognitiivset profiili, saab epilepsiaga laste paremini säilinud kognitiivseid funktsioone kasutada arendusravis. Perinatal stroke occurs during late fetal or newborn life and affects one newborn per thousand live births. Perinatal stroke is divided into different types and brain injury after stroke can vary. These children experience lifelong difficulties in motor, language and cognitive functions, and may develop epilepsy. Perinatal stroke, and especially accompanying epilepsy, can lower the quality of life of these children and their families. Yet, it is still unclear which children with perinatal stroke develop epilepsy and what is the cognitive profile of these children compared to children without epilepsy. The aim of the current study was to investigate the specific features of brain injury that can predict the development and course of epilepsy, and to describe cognitive outcome in children with poststroke epilepsy. The study demonstrated that the risk for developing epilepsy, and the timing and course of epilepsy were different in the case of different stroke types. The risk of epilepsy is the highest in the large stroke of the middle cerebral artery and persists until young adulthood. Children with poststroke epilepsy have a distinct pattern of brain injury which is different from that of children with stroke, but without epilepsy. Despite complications during the course of epilepsy, three fourths of the children with epilepsy are seizure free and more than half of the children are seizure free and off medication by the end of childhood. The general cognitive ability in children with poststroke epilepsy is lower compared to children without epilepsy. At the same time, the profile of specific cognitive functions indicated that in some tests children with poststroke epilepsy performed as well as children without epilepsy. In conclusion, this study suggests that there are certain features of brain injury that can predict poststroke epilepsy, and these should be evaluated by magnet resonance imaging during outcome investigations of children with perinatal stroke. For targeted rehabilitation, assessment of not only general ability, but also of special cognitive abilities, is crucial in order to use less impaired cognitive functions in the rehabilitation of children with epilepsy.