Doctoral defence: Ulvi Vaher "Epilepsy after ischemic perinatal stroke in term born children: neuroimaging predictors, clinical course and cognitive outcome"

On November 29th Ulvi Vaher will defend her thesis "Epilepsy after ischemic perinatal stroke in term born children: neuroimaging predictors, clinical course and cognitive outcome".

Supervisors: 
Professor Pilvi Ilves, University of Tartu
Research fellow Mairi Männamaa, University of Tartu

Opponent: 
Heléne Sundelin, Department of Women's and Children's Health, Karolinska Institutet (Sweden). 

Summary:
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.