Associations of Acute Seizure Patterns With Functional Outcomes, Mortality, and Remote Seizures After Pediatric Ischemic Stroke

BACKGROUND: Acute symptomatic seizures are common after pediatric ischemic stroke, but their associations with recovery, mortality, and later remote seizures, and the role of antiseizure medications, remain uncertain, especially in Chinese cohorts. METHODS: We analyzed a prospective multicenter cohort of children aged 29 days to 18 years with ischemic stroke enrolled in the CPISR (Chinese Pediatric Ischemic Stroke Registry) (January 2022-May 2024). Exposures included acute seizures and antiseizure medications. Outcomes included Pediatric Stroke Outcome Measure at 90 days and 1 year, functional improvement, mortality, and poststroke epilepsy. RESULTS: Among 562 children, 137 had acute seizures, including 30 with status epilepticus and 68 with multiple seizures. In fully adjusted models, status epilepticus was associated with poor 1-year functional outcome (adjusted odds ratio [OR], 6.29 [95% CI, 2.10-19.09]) and higher odds of no functional improvement (adjusted OR, 2.90 [95% CI, 1.08-9.26]); multiple seizures were also associated with no functional improvement (adjusted OR, 2.33 [95% CI, 1.11-5.17]). In exploratory analyses, acute seizures were associated with worse Pediatric Stroke Outcome Measure subdomain scores at both 90 days and 1 year, whereas no independent association with all-cause mortality was observed after full adjustment. Acute seizures were associated with an increased risk of poststroke epilepsy (adjusted hazard ratio, 5.52 [95% CI, 2.63-11.58]), particularly in children presenting with status epilepticus or multiple seizures. Prophylactic and early antiseizure medication use were not significantly associated with outcomes. CONCLUSIONS: Acute status epilepticus and multiple seizures were associated with poorer recovery and higher risk of poststroke epilepsy, supporting risk stratification and targeted follow-up. REGISTRATION: URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2200059915.