Seizures and outcome one year after neonatal and childhood cerebral sinovenous thrombosis

Abstract Background Pediatric cerebral sinovenous thrombosis (CSVT) is a treatable cause of brain injury, acute symptomatic seizures and remote epilepsy. Our objective was to prospectively study epilepsy and neurologic outcomes in neonates and children one year after CSVT diagnosis. Methods Patients with CSVT were enrolled prospectively from 21 international sites through the Seizures in Pediatric Stroke (SIPS) Study. Clinical data including acute symptomatic seizures and CSVT risk factors were collected at diagnosis. A blinded neuroradiologist reviewed acute imaging. At one year, outcomes including seizure recurrence, epilepsy diagnosis, anticonvulsant use, and modified Engel score were collected. Neurological outcomes were assessed using the modified Rankin score (mRS) and the King’s Outcome Scale of Childhood Head Injury (KOSCHI). Results Twenty-four participants with CSVT were enrolled (67% male, 21% neonates). Headache was the most common presenting symptom in non-neonates (47%, 9/19). Nine (37.5%) presented with acute symptomatic seizures. Six (25%; 95% CI = 10%- 47%) developed epilepsy by 1-year follow-up. No clinical predictors associated with epilepsy were identified. KOSCHI and mRS scores at 1 year were favorable in 71%. Half of CSVT patients who developed epilepsy (3/6) did not have infarcts, hemorrhage, or seizures identified during the acute hospitalization Conclusion Our study provides a prospective estimate that epilepsy occurs in approximately one quarter of patients by one year after diagnosis of CSVT. Later epilepsy can develop in the absence of acute seizures or parenchymal injury associated with the CSVT.