AUTHOR=Vaher Ulvi , Ilves Norman , Ilves Nigul , Laugesaar Rael , Männamaa Mairi , Loorits Dagmar , Kool Pille , Ilves Pilvi 

TITLE=The thalamus and basal ganglia are smaller in children with epilepsy after perinatal stroke

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1252472

DOI=10.3389/fneur.2023.1252472

ISSN=1664-2295

ABSTRACT=Background: Epilepsy is one of the most serious consequences of perinatal stroke. Epilepsy itself has been proposed as a risk factor for impaired cognitive, language and behavioral problems. It is still unclear which children develop epilepsy after perinatal stroke. The aim of the current study was to evaluate the volume of the thalamus and the basal ganglia in children after perinatal stroke in relation to poststroke epilepsy.Methods: The follow-up study included 29 children with perinatal arterial ischemic stroke (AIS), 33 children with presumed periventricular venous infarction (PVI) and 46 age-and sex-matched healthy controls. Magnetic resonance imaging was perfomed at the age of 4-18 years and volumetric analysis by segmentation was used to evaluate the size of the thalamus, caudate nucleus, putamen, globus pallidus, hippocampus, amygdala and nucleus accumbens.Results: During a median follow-up time of 12.8 years (interquartile range (IQR): 10.8-17.3) in the AIS group and 12.5 years (IQR: 9.3-14.8) in the PVI group (p=0.32) epilepsy developed in 10 children (34.5%) with AIS and in 4 (12.1%) children with PVI, p=0.036 (odds ratio (OR)=3.8, 95%, confidence interval (CI): 1.04-14). Epilepsy and interictal epileptiform discharges (IED) without clinical seizures were more often expressed in children with AIS (n=16, 55%) than in children with PVI (n=7, 21.2%), p=0.0057 (OR=3.8 95%CI: 1.04-14). In the AIS group ipsi-and contralesional thalamus, ipsilesional caudate nucleus and nucleus accumbens were significantly smaller in children with epilepsy compared to children without epilepsy. In the PVI group the ipsilesional thalamus, caudate nucleus, and nucleus accumbens were smaller in the pooled group of epilepsy plus IED alone, compared to children without epilepsy.Conclusions: In children with AIS, epilepsy or IED occurred more often compared to children with PVI. Both patients with AIS and PVI with severe damage to the basal ganglia and the thalamus are at a higher risk for development of poststroke epilepsy and should be monitored more closely throughout childhood to initiate timely antiseizure medication and rehabilitation.