Investigators at Yale University School of Medicine, New Haven, CT; Children's Hospital of Philadelphia; Vanderbilt University, Nashville, TN; and Johns Hopkins University, studied the incidence and risk factors for seizures and epilepsy in 73 children with spontaneous intracerebral hemorrhage (ICH) including 20 perinatal subjects (>37 weeks gestation to 28 days) and 53 aged >28 days to <18 years at presentation. Acute symptomatic seizures occurred in 35 subjects (48%); they were a presenting symptom of ICH in 12 perinatal (60%) and 19 childhood (36%) subjects, and they occurred afterpresentation in 7. Electroencephalographic-only seizures occurred in 9 of 32 subjects (28%) with continuous EEG monitoring. One-year and 2-year remote symptomatic seizure-free survival rates were 82% and 67%, respectively. One-year and two-year epilepsy-free survival rates were 96% and 87%, respectively. Elevated intracranial pressure requiring acute intervention was a risk factor for seizures after presentation (P=0.01), for remote symptomatic seizures (P=0.03), and epilepsy (P=0.04). Single remote symptomatic seizures occur in many, and epilepsy is estimated to develop in 13% patients at 2 years after ICH presentation. [1]

COMMENT. Acute symptomatic seizures were defined as those occurring up to 7 days after the incident ICH, and remote symptomatic seizures as occurring beyond 7 days from ICH presentation. An editorial points out that acute symptomatic seizures with ICH occur more frequently in children (60%) than in adult reports (7%-31%). [2]