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Master Thesis

Continuous spikes and waves during sleep in perinatal stroke: a multicentric case control study

Abstract : Objective: the main one is to determine associated factors to develop a continuous spikes and waves during slow sleep (CSWS) syndrome after a focal perinatal stroke. Then we discuss the impact of CSWS and others releavant factors on neurocognitive outcome in each group. Methods: we performed a multicentric case-control study and enrolled 1) patients born at term >37SA with a perinatal stroke (from 20 gestational weeks to 28e day post-natal) 2) one or more brain MRI and 4) 2 or more overnight EEG recordings. Anoxie encephalopathy and bilateral brain injury were exclusion criteria. We determined two groups: stroke-CSWS (cases) and stroke-no CSWS (controls), first group was defined by clinical features consistent with a sleep potentiate epileptiform activity more than 85% during non-REM sleep. Results: A sample of 26 patients with perinatal stroke met the inclusion criteria during a 15 year period: 16 stroke-CSWS and 10 stroke-no CSWS. Both groups were comparable in terms of epidemiologic features, degree of cerebral palsy and stroke presentation. Child presenting a prolonged hemicorporal focal seizure with or not fever after 18 months were more able to develop a CSWS (87.5 % vs 0%, p <0.001). Presence yet in awake EEGs of fronto-central spike or spike waves with a bilateral synchrony trend, especially when no improvement was seen with recommended antiepileptic drug and a first association with benzodiazepines, was a strong marker for an evolution towards CSWS (62.5% vs 0%, p=0.002%). Subcortical lesion with thalamus involvement was not statistically higher in CSWS patients but cortical sparing was more frequent in CSWS (43.7% vs 0%, p=0.02). Superficial arterial ischemic MCA was less frequent in CSWS (6.3% vs 50%, p=0.02). Global cognitive outcome was poor in CSWS patients but not in all cases with 25% poor, 38% favorable and 37% difficult issue although 75% of no CSWS had a favorable outcome regarding schooling and neuropsychometric data. The only two factors who seemed associated with a poor global cognitive outcome were presence of CSWS and/or regression (33.3% vs 60%, p=0.01) Conclusions: A combined factor associating anatomical (MRI) and functional (sleep EEGs at a critical age) data should reach pertinence to predict epilepsy and cognition outcome after perinatal stroke. Further studies should investigate this opportunity.
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Master Thesis
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Submitted on : Monday, June 15, 2015 - 4:13:17 PM
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  • HAL Id : dumas-01163833, version 1


Alexa Garros. Continuous spikes and waves during sleep in perinatal stroke: a multicentric case control study. Human health and pathology. 2015. ⟨dumas-01163833⟩



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