1
|
Tanaka T, Ihara M, Fukuma K, Mishra NK, Koepp MJ, Guekht A, Ikeda A. Pathophysiology, Diagnosis, Prognosis, and Prevention of Poststroke Epilepsy: Clinical and Research Implications. Neurology 2024; 102:e209450. [PMID: 38759128 PMCID: PMC11175639 DOI: 10.1212/wnl.0000000000209450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/13/2024] [Indexed: 05/19/2024] Open
Abstract
Poststroke epilepsy (PSE) is associated with higher mortality and poor functional and cognitive outcomes in patients with stroke. With the remarkable development of acute stroke treatment, there is a growing number of survivors with PSE. Although approximately 10% of patients with stroke develop PSE, given the significant burden of stroke worldwide, PSE is a significant problem in stroke survivors. Therefore, the attention of health policymakers and significant funding are required to promote PSE prevention research. The current PSE definition includes unprovoked seizures occurring more than 7 days after stroke onset, given the high recurrence risks of seizures. However, the pathologic cascade of stroke is not uniform, indicating the need for a tissue-based approach rather than a time-based one to distinguish early seizures from late seizures. EEG is a commonly used tool in the diagnostic work-up of PSE. EEG findings during the acute phase of stroke can potentially stratify the risk of subsequent seizures and predict the development of poststroke epileptogenesis. Recent reports suggest that cortical superficial siderosis, which may be involved in epileptogenesis, is a promising marker for PSE. By incorporating such markers, future risk-scoring models could guide treatment strategies, particularly for the primary prophylaxis of PSE. To date, drugs that prevent poststroke epileptogenesis are lacking. The primary challenge involves the substantial cost burden due to the difficulty of reliably enrolling patients who develop PSE. There is, therefore, a critical need to determine reliable biomarkers for PSE. The goal is to be able to use them for trial enrichment and as a surrogate outcome measure for epileptogenesis. Moreover, seizure prophylaxis is essential to prevent functional and cognitive decline in stroke survivors. Further elucidation of factors that contribute to poststroke epileptogenesis is eagerly awaited. Meanwhile, the regimen of antiseizure medications should be based on individual cardiovascular risk, psychosomatic comorbidities, and concomitant medications. This review summarizes the current understanding of poststroke epileptogenesis, its risks, prognostic models, prophylaxis, and strategies for secondary prevention of seizures and suggests strategies to advance research on PSE.
Collapse
Affiliation(s)
- Tomotaka Tanaka
- From the Department of Neurology (T.T., M.I., K.F.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology (N.K.M.), Yale University School of Medicine, New Haven, CT; Department of Clinical & Experimental Epilepsy (M.J.K.), UCL Queen Square Institute of Neurology, London, United Kingdom; Moscow Research and Clinical Center for Neuropsychiatry (A.G.), Pirogov Russian National Research Medical University, Russia; and Department of Epilepsy, Movement Disorders and Physiology (A.I.), Kyoto University Graduate School of Medicine, Japan
| | - Masafumi Ihara
- From the Department of Neurology (T.T., M.I., K.F.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology (N.K.M.), Yale University School of Medicine, New Haven, CT; Department of Clinical & Experimental Epilepsy (M.J.K.), UCL Queen Square Institute of Neurology, London, United Kingdom; Moscow Research and Clinical Center for Neuropsychiatry (A.G.), Pirogov Russian National Research Medical University, Russia; and Department of Epilepsy, Movement Disorders and Physiology (A.I.), Kyoto University Graduate School of Medicine, Japan
| | - Kazuki Fukuma
- From the Department of Neurology (T.T., M.I., K.F.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology (N.K.M.), Yale University School of Medicine, New Haven, CT; Department of Clinical & Experimental Epilepsy (M.J.K.), UCL Queen Square Institute of Neurology, London, United Kingdom; Moscow Research and Clinical Center for Neuropsychiatry (A.G.), Pirogov Russian National Research Medical University, Russia; and Department of Epilepsy, Movement Disorders and Physiology (A.I.), Kyoto University Graduate School of Medicine, Japan
| | - Nishant K Mishra
- From the Department of Neurology (T.T., M.I., K.F.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology (N.K.M.), Yale University School of Medicine, New Haven, CT; Department of Clinical & Experimental Epilepsy (M.J.K.), UCL Queen Square Institute of Neurology, London, United Kingdom; Moscow Research and Clinical Center for Neuropsychiatry (A.G.), Pirogov Russian National Research Medical University, Russia; and Department of Epilepsy, Movement Disorders and Physiology (A.I.), Kyoto University Graduate School of Medicine, Japan
| | - Matthias J Koepp
- From the Department of Neurology (T.T., M.I., K.F.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology (N.K.M.), Yale University School of Medicine, New Haven, CT; Department of Clinical & Experimental Epilepsy (M.J.K.), UCL Queen Square Institute of Neurology, London, United Kingdom; Moscow Research and Clinical Center for Neuropsychiatry (A.G.), Pirogov Russian National Research Medical University, Russia; and Department of Epilepsy, Movement Disorders and Physiology (A.I.), Kyoto University Graduate School of Medicine, Japan
| | - Alla Guekht
- From the Department of Neurology (T.T., M.I., K.F.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology (N.K.M.), Yale University School of Medicine, New Haven, CT; Department of Clinical & Experimental Epilepsy (M.J.K.), UCL Queen Square Institute of Neurology, London, United Kingdom; Moscow Research and Clinical Center for Neuropsychiatry (A.G.), Pirogov Russian National Research Medical University, Russia; and Department of Epilepsy, Movement Disorders and Physiology (A.I.), Kyoto University Graduate School of Medicine, Japan
| | - Akio Ikeda
- From the Department of Neurology (T.T., M.I., K.F.), National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology (N.K.M.), Yale University School of Medicine, New Haven, CT; Department of Clinical & Experimental Epilepsy (M.J.K.), UCL Queen Square Institute of Neurology, London, United Kingdom; Moscow Research and Clinical Center for Neuropsychiatry (A.G.), Pirogov Russian National Research Medical University, Russia; and Department of Epilepsy, Movement Disorders and Physiology (A.I.), Kyoto University Graduate School of Medicine, Japan
| |
Collapse
|
2
|
Šmigelskytė A, Rimkuvienė G, Žukaitė D, Repečkaitė G, Jurkevičienė G. The Association of Epileptic Seizures after Acute Ischemic Stroke with Cerebral Cortical Involvement and Electroencephalographic Changes. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:768. [PMID: 38792951 PMCID: PMC11123067 DOI: 10.3390/medicina60050768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
Background and objectives: while acute ischemic stroke is the leading cause of epilepsy in the elderly population, data about its risk factors have been conflicting. Therefore, the aim of our study is to determine the association of early and late epileptic seizures after acute ischemic stroke with cerebral cortical involvement and electroencephalographic changes. Materials and methods: a prospective cohort study in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics Department of Neurology was conducted and enrolled 376 acute ischemic stroke patients. Data about the demographical, clinical, radiological, and encephalographic changes was gathered. Patients were followed for 1 year after stroke and assessed for late ES. Results: the incidence of ES was 4.5%, the incidence of early ES was 2.7% and the incidence of late ES was 2.4%. The occurrence of early ES increased the probability of developing late ES. There was no association between acute cerebral cortical damage and the occurrence of ES, including both early and late ES. However, interictal epileptiform discharges were associated with the occurrence of ES, including both early and late ES.
Collapse
Affiliation(s)
- Agnė Šmigelskytė
- Department of Neurology, Lithuanian University of Health Sciences, A. Mickevičiaus Str. 9, LT-44307 Kaunas, Lithuania
| | - Gabija Rimkuvienė
- Department of Neurology, Lithuanian University of Health Sciences, A. Mickevičiaus Str. 9, LT-44307 Kaunas, Lithuania
| | - Dominyka Žukaitė
- Department of Neurology, Lithuanian University of Health Sciences, A. Mickevičiaus Str. 9, LT-44307 Kaunas, Lithuania
| | - Gerta Repečkaitė
- Department of Radiology, Lithuanian University of Health Sciences, A. Mickevičiaus Str. 9, LT-44307 Kaunas, Lithuania
| | - Giedrė Jurkevičienė
- Department of Neurology, Lithuanian University of Health Sciences, A. Mickevičiaus Str. 9, LT-44307 Kaunas, Lithuania
| |
Collapse
|
3
|
Pellinen J, Foster EC, Wilmshurst JM, Zuberi SM, French J. Improving epilepsy diagnosis across the lifespan: approaches and innovations. Lancet Neurol 2024; 23:511-521. [PMID: 38631767 DOI: 10.1016/s1474-4422(24)00079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024]
Abstract
Epilepsy diagnosis is often delayed or inaccurate, exposing people to ongoing seizures and their substantial consequences until effective treatment is initiated. Important factors contributing to this problem include delayed recognition of seizure symptoms by patients and eyewitnesses; cultural, geographical, and financial barriers to seeking health care; and missed or delayed diagnosis by health-care providers. Epilepsy diagnosis involves several steps. The first step is recognition of epileptic seizures; next is classification of epilepsy type and whether an epilepsy syndrome is present; finally, the underlying epilepsy-associated comorbidities and potential causes must be identified, which differ across the lifespan. Clinical history, elicited from patients and eyewitnesses, is a fundamental component of the diagnostic pathway. Recent technological advances, including smartphone videography and genetic testing, are increasingly used in routine practice. Innovations in technology, such as artificial intelligence, could provide new possibilities for directly and indirectly detecting epilepsy and might make valuable contributions to diagnostic algorithms in the future.
Collapse
Affiliation(s)
- Jacob Pellinen
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Emma C Foster
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jo M Wilmshurst
- Red Cross War Memorial Children's Hospital and University of Cape Town Neuroscience Institute, Cape Town, South Africa
| | - Sameer M Zuberi
- Royal Hospital for Children and University of Glasgow School of Health & Wellbeing, Glasgow, UK
| | - Jacqueline French
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
4
|
Wang Y, Zuo H, Li W, Wu X, Zhou F, Chen X, Liu F, Xi Z. Cerebral small vessel disease increases risk for epilepsy: a Mendelian randomization study. Neurol Sci 2024; 45:2171-2180. [PMID: 38012465 DOI: 10.1007/s10072-023-07221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Despite previous research suggesting a potential association between cerebral small vessel disease (CSVD) and epilepsy, the precise causality and directionality between cerebral small vessel disease (CSVD) and epilepsy remain incompletely understood. We aimed to investigate the causal link between CSVD and epilepsy. METHOD A bidirectional two-sample Mendelian randomization (MR) analysis was performed to evaluate the causal relationship between CSVD and epilepsy. The analysis included five dimensions of CSVD, namely small vessel ischemic stroke (SVS), intracerebral hemorrhage (ICH), white matter damage (including white matter hyperintensity [WMH], fractional anisotropy, and mean diffusivity), lacunar stroke, and cerebral microbleeds. We also incorporated epilepsy encompassing both focal epilepsy and generalized epilepsy. Inverse variance weighted (IVW) was used as the primary estimate while other four MR techniques were used to validate the results. Pleiotropic effects were controlled by adjusting vascular risk factors through multivariable MR. RESULT The study found a significant association between SVS (odds ratio [OR] 1.117, PFDR = 0.022), fractional anisotropy (OR 0.961, PFDR = 0.005), mean diffusivity (OR 1.036, PFDR = 0.004), and lacunar stroke (OR 1.127, PFDR = 0.007) with an increased risk of epilepsy. The aforementioned correlations primarily occurred in focal epilepsy rather than generalized epilepsy on subgroup analysis and retained their significance in the multivariable MR analysis. CONCLUSION Our study demonstrated that genetic susceptibility to CSVD independently elevates the risk of epilepsy, especially focal epilepsy. Diffusion tensor imaging may help screen patients at high risk for epilepsy in CSVD. Improved management of CSVD may be a significant approach in reducing the overall prevalence of epilepsy.
Collapse
Affiliation(s)
- Yuzhu Wang
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1St Youyi Road, Chongqing, 400016, China
| | - Hongzhou Zuo
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1St Youyi Road, Chongqing, 400016, China
| | - Wei Li
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaohui Wu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1St Youyi Road, Chongqing, 400016, China
| | - Fu Zhou
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1St Youyi Road, Chongqing, 400016, China
| | - Xuan Chen
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1St Youyi Road, Chongqing, 400016, China
| | - Fei Liu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1St Youyi Road, Chongqing, 400016, China
| | - Zhiqin Xi
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1St Youyi Road, Chongqing, 400016, China.
| |
Collapse
|
5
|
Ha WS, Jang K, Cho S, Kim WJ, Chu MK, Heo K, Kim KM. Risk Factors and Temporal Patterns of Poststroke Epilepsy across Stroke Subtypes: Insights from a Nationwide Cohort Study in Korea. Neuroepidemiology 2024:1-11. [PMID: 38599180 DOI: 10.1159/000538776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION We aimed to investigate the risk factors associated with poststroke epilepsy (PSE) among patients with different subtypes of stroke, focusing on age-related risk and time-varying effects of stroke subtypes on PSE development. METHODS A retrospective, nationwide, population-based cohort study was conducted using Korean National Health Insurance Service-National Sample Cohort data. Patients hospitalized with newly diagnosed stroke from 2005 to 2015 were included and followed up for up to 10 years. The primary outcome was the development of PSE, defined as having a diagnostic code and a prescription for anti-seizure medication. Multivariable Cox proportional hazard models were used to estimate PSE hazard ratios (HRs), and time-varying effects were also assessed. RESULTS A total of 8,305 patients with ischemic stroke, 1,563 with intracerebral hemorrhage (ICH), and 931 with subarachnoid hemorrhage (SAH) were included. During 10 years of follow-up, 4.6% of patients developed PSE. Among patients with ischemic stroke, significant risk factors for PSE were younger age (HR = 1.47), living in rural areas (HR = 1.35), admission through the emergency room (HR = 1.33), and longer duration of hospital stay (HR = 1.45). Time-varying analysis revealed elevated HRs for ICH and SAH, particularly in the first 2 years following the stroke. The age-specific HRs also showed an increased risk for those under the age of 65, with a noticeable decrease in risk beyond that age. CONCLUSION The risk of developing PSE varies according to stroke subtype, age, and other demographic factors. These findings underscore the importance of tailored poststroke monitoring and management strategies to mitigate the risk of PSE.
Collapse
Affiliation(s)
- Woo-Seok Ha
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kimoon Jang
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
6
|
Ebner L, Lochner P, Lattanzi S, Brigo F, Wagenpfeil G, Faßbender K, Röll F. Neutrophil to lymphocyte ratio and early seizures after ischemic stroke: A case-control study. Epilepsy Behav 2024; 152:109660. [PMID: 38364334 DOI: 10.1016/j.yebeh.2024.109660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/04/2024] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Early post-stroke seizures (EPSS) are associated with an increased risk of mortality and post-stroke epilepsy. This study aimed to identify potential risk factors for EPSS, focusing on blood parameters, such as the neutrophil-to-lymphocyte ratio (NLR), which is a biomarker for inflammation. METHODS Patients treated for ischemic stroke between 2017 and 2019 were retrospectively identified. 44 of them had a first epileptic seizure within 7 days after the stroke. They were matched 1:2 for age and sex with controls who had a stroke but no EPSS. Information on demographics, stroke characteristics, and blood parameters were collected on admission. Logistic regression was used to identify variables associated with EPSS and the area under the receiver operating characteristic curve (AUROC) to estimate their predictive accuracy. RESULTS The NLR value (p = 0.035), National Institutes of Health Stroke Scale (NIHSS) (p = 0.016) and cortical localization of stroke (p = 0.03) were significantly correlated with the occurrence of EPSS in univariate logistic regression. In multivariable logistic regression, after adjusting for age, sex, baseline NIHSS, and stroke localization, the NLR values [adjusted odds ratio 1.097, 95% confidence interval (CI): 1.005-1.197; p = 0.038] were independently associated with the occurrence of EPSS. The AUROC for NLR was 0.639 (95% CI: 0.517-0.761) with 2.98 as the best predictive cut-off value. There was a significant positive relationship between NLR and NIHSS, rS(87) = 0.383, p = <0.001. CONCLUSION Higher NLR values were associated with increased risk of EPSS. This biomarker appears useful to assess the risk of developing EPSS.
Collapse
Affiliation(s)
- Lea Ebner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany.
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany
| | - Klaus Faßbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Frauke Röll
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
7
|
Hlauschek G, Nicolo J, Sinclair B, Law M, Yasuda CL, Cendes F, Lossius MI, Kwan P, Vivash L. Role of the glymphatic system and perivascular spaces as a potential biomarker for post-stroke epilepsy. Epilepsia Open 2024; 9:60-76. [PMID: 38041607 PMCID: PMC10839409 DOI: 10.1002/epi4.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/29/2023] [Indexed: 12/03/2023] Open
Abstract
Stroke is one of the most common causes of acquired epilepsy, which can also result in disability and increased mortality rates particularly in elderly patients. No preventive treatment for post-stroke epilepsy is currently available. Development of such treatments has been greatly limited by the lack of biomarkers to reliably identify high-risk patients. The glymphatic system, including perivascular spaces (PVS), is the brain's waste clearance system, and enlargement or asymmetry of PVS (ePVS) is hypothesized to play a significant role in the pathogenesis of several neurological conditions. In this article, we discuss potential mechanisms for the role of perivascular spaces in the development of post-stroke epilepsy. Using advanced MR-imaging techniques, it has been shown that there is asymmetry and impairment of glymphatic function in the setting of ischemic stroke. Furthermore, studies have described a dysfunction of PVS in patients with different focal and generalized epilepsy syndromes. It is thought that inflammatory processes involving PVS and the blood-brain barrier, impairment of waste clearance, and sustained hypertension affecting the glymphatic system during a seizure may play a crucial role in epileptogenesis post-stroke. We hypothesize that impairment of the glymphatic system and asymmetry and dynamics of ePVS in the course of a stroke contribute to the development of PSE. Automated ePVS detection in stroke patients might thus assist in the identification of high-risk patients for post-stroke epilepsy trials. PLAIN LANGUAGE SUMMARY: Stroke often leads to epilepsy and is one of the main causes of epilepsy in elderly patients, with no preventative treatment available. The brain's waste removal system, called the glymphatic system which consists of perivascular spaces, may be involved. Enlargement or asymmetry of perivascular spaces could play a role in this and can be visualised with advanced brain imaging after a stroke. Detecting enlarged perivascular spaces in stroke patients could help identify those at risk for post-stroke epilepsy.
Collapse
Affiliation(s)
- Gernot Hlauschek
- Division of Clinical Neuroscience, National Centre for Epilepsy, member of ERN EpicareOslo University HospitalNorway
- The University of OsloOsloNorway
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - John‐Paul Nicolo
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe University of Melbourne, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Benjamin Sinclair
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
| | - Meng Law
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of RadiologyThe AlfredMelbourneVictoriaAustralia
| | | | | | - Morten Ingvar Lossius
- Division of Clinical Neuroscience, National Centre for Epilepsy, member of ERN EpicareOslo University HospitalNorway
- The University of OsloOsloNorway
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe University of Melbourne, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Lucy Vivash
- Department of Neurosciences, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe AlfredMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe University of Melbourne, Royal Melbourne HospitalParkvilleVictoriaAustralia
| |
Collapse
|
8
|
Paungarttner J, Quartana M, Patti L, Sklenárová B, Farham F, Jiménez IH, Soylu MG, Vlad IM, Tasdelen S, Mateu T, Marsico O, Reina F, Tischler V, Lampl C. Migraine - a borderland disease to epilepsy: near it but not of it. J Headache Pain 2024; 25:11. [PMID: 38273253 PMCID: PMC10811828 DOI: 10.1186/s10194-024-01719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Migraine and epilepsy are two paroxysmal chronic neurological disorders affecting a high number of individuals and being responsible for a high individual and socioeconomic burden. The link between these disorders has been of interest for decades and innovations concerning diagnosing and treatment enable new insights into their relationship. FINDINGS Although appearing to be distinct at first glance, both diseases exhibit a noteworthy comorbidity, shared pathophysiological pathways, and significant overlaps in characteristics like clinical manifestation or prophylactic treatment. This review aims to explore the intricate relationship between these two conditions, shedding light on shared pathophysiological foundations, genetic interdependencies, common and distinct clinical features, clinically overlapping syndromes, and therapeutic similarities. There are several shared pathophysiological mechanisms, like CSD, the likely underlying cause of migraine aura, or neurotransmitters, mainly Glutamate and GABA, which represent important roles in triggering migraine attacks and seizures. The genetic interrelations between the two disorders can be observed by taking a closer look at the group of familial hemiplegic migraines, which are caused by mutations in genes like CACNA1A, ATP1A2, or SCN1A. The intricate relationship is further underlined by the high number of shared clinical features, which can be observed over the entire course of migraine attacks and epileptic seizures. While the variety of the clinical manifestation of an epileptic seizure is naturally higher than that of a migraine attack, a distinction can indeed be difficult in some cases, e.g. in occipital lobe epilepsy. Moreover, triggering factors like sleep deprivation or alcohol consumption play an important role in both diseases. In the period after the seizure or migraine attack, symptoms like speech difficulties, tiredness, and yawning occur. While the actual attack of the disease usually lasts for a limited time, research indicates that individuals suffering from migraine and/or epilepsy are highly affected in their daily life, especially regarding cognitive and social aspects, a burden that is even worsened using antiseizure medication. This medication allows us to reveal further connections, as certain antiepileptics are proven to have beneficial effects on the frequency and severity of migraine and have been used as a preventive drug for both diseases over many years. CONCLUSION Migraine and epilepsy show a high number of similarities in their mechanisms and clinical presentation. A deeper understanding of the intricate relationship will positively advance patient-oriented research and clinical work.
Collapse
Affiliation(s)
| | - Martina Quartana
- Department of Sciences for Health Promotion and Mother-and Childcare "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Lucrezia Patti
- Department of Sciences for Health Promotion and Mother-and Childcare "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Barbora Sklenárová
- St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Fatemeh Farham
- Headache Department, Iranian Center of Neurological Researchers, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - M Gokcen Soylu
- Department of Neurology, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey
| | - Irina Maria Vlad
- Department of Neurosciences, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Semih Tasdelen
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Teresa Mateu
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Neurology, Fundació Sanitària Mollet, Mollet del Vallès, Barcelona, Spain
| | - Oreste Marsico
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospitall", Reggio Calabria, Italy
| | - Federica Reina
- NeuroTeam Life&Science, Spin-off University of Palermo, Palermo, Italy
| | - Viktoria Tischler
- Headache Medical Center Linz, Linz, Austria
- Department of Neurology and Stroke Unit, Konventhospital Barmherzige Brüder Linz, Linz, Austria
| | - Christian Lampl
- Headache Medical Center Linz, Linz, Austria.
- Department of Neurology and Stroke Unit, Konventhospital Barmherzige Brüder Linz, Linz, Austria.
| |
Collapse
|
9
|
Fu CH, You JC, Mohila C, Rissman RA, Yoshor D, Viaene AN, Chin J. Hippocampal ΔFosB expression is associated with cognitive impairment in a subgroup of patients with childhood epilepsies. Front Neurol 2024; 14:1331194. [PMID: 38274865 PMCID: PMC10808715 DOI: 10.3389/fneur.2023.1331194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Epilepsy is a chronic neurological disorder characterized by recurrent seizures, and is often comorbid with other neurological and neurodegenerative diseases, such as Alzheimer's disease (AD). Patients with recurrent seizures often present with cognitive impairment. However, it is unclear how seizures, even when infrequent, produce long-lasting deficits in cognition. One mechanism may be seizure-induced expression of ΔFosB, a long-lived transcription factor that persistently regulates expression of plasticity-related genes and drives cognitive dysfunction. We previously found that, compared with cognitively-intact subjects, the activity-dependent expression of ΔFosB in the hippocampal dentate gyrus (DG) was increased in individuals with mild cognitive impairment (MCI) and in individuals with AD. In MCI patients, higher ΔFosB expression corresponded to lower Mini-Mental State Examination scores. Surgically resected DG tissue from patients with temporal lobe epilepsy also showed robust ΔFosB expression; however, it is unclear whether ΔFosB expression also corresponds to cognitive dysfunction in non-AD-related epilepsy. To test whether DG ΔFosB expression is indicative of cognitive impairment in epilepsies with different etiologies, we assessed ΔFosB expression in surgically-resected hippocampal tissue from 33 patients with childhood epilepsies who had undergone Wechsler Intelligence Scale for Children (WISC) testing prior to surgery. We found that ΔFosB expression is inversely correlated with Full-Scale Intelligence Quotient (FSIQ) in patients with mild to severe intellectual disability (FSIQ < 85). Our data indicate that ΔFosB expression corresponds to cognitive impairment in epilepsies with different etiologies, supporting the hypothesis that ΔFosB may epigenetically regulate gene expression and impair cognition across a wide range of epilepsy syndromes.
Collapse
Affiliation(s)
- Chia-Hsuan Fu
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Jason C. You
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Carrie Mohila
- Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, United States
| | - Robert A. Rissman
- Department of Neurosciences, University of California San Diego School of Medicine, La Jolla, CA, United States
- Veteran's Affairs (VA) San Diego Healthcare System, San Diego, CA, United States
| | - Daniel Yoshor
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Angela N. Viaene
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeannie Chin
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| |
Collapse
|
10
|
Freiman S, Hauser WA, Rider F, Gulyaeva N, Guekht A. Post-stroke epilepsy: From clinical predictors to possible mechanisms. Epilepsy Res 2024; 199:107282. [PMID: 38134643 DOI: 10.1016/j.eplepsyres.2023.107282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Stroke is the most common cause of newly diagnosed epilepsy in the elderly, ahead of degenerative disorders, brain tumors, and head trauma. Stroke accounts for 30-50% of unprovoked seizures in patients aged ≥ 60 years. This review discusses the current understanding of epidemiology, risk factors, mechanisms, prevention, and treatment opportunities for post-stroke epilepsy (PSE). METHODS We performed a literature search in the PubMed and Cochrane Library databases. The keywords "stroke, epilepsy", "stroke, seizure", "post-stroke seizure", "post-stroke epilepsy" were used to identify the clinical and experimental articles on PSE. All resulting titles and abstracts were evaluated, and any relevant article was considered. The reference lists of all selected papers and reference lists of selected review papers were manually analyzed to find other potentially eligible articles. RESULTS PSE occurs in about 6% of stroke patients within several years after the event. The main risk factors are cortical lesion, initial stroke severity, young age and seizures in acute stroke period (early seizures, ES). Other risk factors, such as a cardioembolic mechanism or circulation territory involvement, remain debated. The role of ES as a risk factor of PSE could be underestimated especially in young age. Mechanism of epileptogenesis may involve gliosis scarring, alteration in synaptic plasticity, etc.; and ES may enhance these processes. Statins especially in the acute period of stroke are possible agents for PSE prevention presumably due to their anticonvulsant and neuroprotection effects. Antiepileptic drugs (AED) monotherapy is enough for seizure prevention in most cases of PSE; but no evidence was found for its efficiency against epileptic foci formation. The growing interest in PSE has led to a notable increase in the number of published articles each year. To aid in navigating this expanding body of literature, several tables are included in the manuscript. CONCLUSION Further studies are needed for better understanding of the pathophysiology of PSE and searching the prevention strategies.
Collapse
Affiliation(s)
- Sofia Freiman
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation.
| | - W Allen Hauser
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, New York, USA
| | - Flora Rider
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation
| | - Natalia Gulyaeva
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Buyanov City Hospital of the Healthcare Department of Moscow, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Moscow, Russian Federation
| |
Collapse
|
11
|
Brigo F, Zelano J, Abraira L, Bentes C, Ekdahl CT, Lattanzi S, Ingvar Lossius M, Redfors P, Rouhl RPW, Russo E, Sander JW, Vogrig A, Wickström R. Proceedings of the "International Congress on Structural Epilepsy & Symptomatic Seizures" (STESS, Gothenburg, Sweden, 29-31 March 2023). Epilepsy Behav 2024; 150:109538. [PMID: 38039602 DOI: 10.1016/j.yebeh.2023.109538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
| | - Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Laura Abraira
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carla Bentes
- Neurophysiological Monitoring Unit - EEG/Sleep Laboratory, Refractory Epilepsy Reference Centre (member of EpiCARE), Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro de Estudos Egas Moniz, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Christine T Ekdahl
- Division of Clinical Neurophysiology and Department of Clinical Sciences, Lund University, Sweden; Lund Epilepsy Center, Department of Clinical Sciences, Lund University, Sweden
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Morten Ingvar Lossius
- National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Member of the ERN EpiCARE, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petra Redfors
- Department of Neurology, Member of the ERN EpiCARE, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Centre+, Maastricht, The Netherlands; Academic Centre for Epileptology Kempenhaeghe/MUMC+ Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Italy
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK; Centre for Epilepsy, Chalfont St Peter, Bucks., SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, The Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 610041, China
| | - Alberto Vogrig
- Department of Medicine (DAME), University of Udine, Udine, Italy; Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Ronny Wickström
- Neuropediatric Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
12
|
Tatillo C, Legros B, Depondt C, Rikir E, Naeije G, Jodaïtis L, Ligot N, Gaspard N. Prognostic value of early electrographic biomarkers of epileptogenesis in high-risk ischaemic stroke patients. Eur J Neurol 2024; 31:e16074. [PMID: 37754551 DOI: 10.1111/ene.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/15/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND PURPOSE Post-stroke epilepsy (PSE) is frequent. Better prediction of PSE would enable individualized management and improve trial design for epilepsy prevention. The aim was to assess the complementary value of continuous electroencephalography (EEG) data during the acute phase compared with clinical risk factors currently used to predict PSE. METHODS A prospective cohort of 81 patients with ischaemic stroke who received early continuous EEG monitoring was studied to assess the association of early EEG seizures, other highly epileptogenic rhythmic and periodic patterns, and regional attenuation without delta (RAWOD, an EEG pattern of stroke severity) with PSE. Clinical risk factors were investigated using the SeLECT (stroke severity; large-artery atherosclerosis; early clinical seizures; cortical involvement; territory of middle cerebral artery) scores. RESULTS Twelve (15%) patients developed PSE. The presence of any of the investigated patterns was associated with a risk of epilepsy of 46%, with a sensitivity and specificity of 83% and 78%. The association remained significant after adjusting for the SeLECT score (odds ratio 18.8, interquartile range 3.8-72.7). CONCLUSIONS It was found that highly epileptogenic rhythmic and periodic patterns and RAWOD were associated with the development of PSE and complemented clinical risk factors. These findings indicate that continuous EEG provides useful information to determine patients at higher risk of developing PSE and could help individualize care.
Collapse
Affiliation(s)
- Chiara Tatillo
- Department of Neurology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Benjamin Legros
- Department of Neurology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Chantal Depondt
- Department of Neurology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium
- Laboratory of Experimental Neurology, Université Libre de Bruxelles, Brussels, Belgium
| | - Estelle Rikir
- Department of Neurology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Lise Jodaïtis
- Department of Neurology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Noémie Ligot
- Department of Neurology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium
- Laboratory of Experimental Neurology, Université Libre de Bruxelles, Brussels, Belgium
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
13
|
Zaccara G, Lattanzi S, Brigo F. Acute symptomatic seizures after stroke: A scoping review on primary prevention, treatment with antiseizure medications and drug discontinuation. Epilepsy Behav 2023; 149:109499. [PMID: 37972420 DOI: 10.1016/j.yebeh.2023.109499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
AIM To evaluate and synthesize the evidence and knowledge gaps on primary prevention and treatment of post-stroke acute symptomatic seizures (ASSs) using antiseizure medications (ASMs). METHODS We systematically searched of EMBASE, MEDLINE (accessed from PubMed), and the Cochrane Central Register of Controlled Trials (CENTRAL) to include randomized, double- or single-blinded trials (RCTs) on primary prophylaxis and treatment of post-stroke ASSs with ASMs. The risk of bias in the included studies was assessed according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Two placebo-controlled RCTs (totaling 114 participants) evaluating valproate or levetiracetam as primary prophylaxis of ASSs due to hemorrhagic stroke were included. In one RCT, post-stroke ASS occurred in 1/36 patients (2.7%) on valproate and in 4/36 patients (7%) on placebo (p = 0.4). In the other RCT, ASSs were only electrographic and occurred in 3/19 (16%) with levetiracetam and in 10/23 (43%) with placebo (p = 0.043). We found no RCTs on the treatment of post-stroke ASSs or discontinuation of ASMs administered for the treatment of post-stroke ASSs. CONCLUSION Evidence to support primary prophylaxis of ASSs is sparse and of very low quality and is insufficient to recommend it routinely. Secondary prevention of post-stroke ASSs is usually not recommended except in selected cases (the most relevant being acute symptomatic status epilepticus, which carries a high risk of subsequent poststroke seizures (PSE)). The choice of which ASM to administer and for how long is not based on solid RCT evidence. Management of post-stroke PSE should be done according to an evidence-based framework, considering the individuality of the patient and the pharmacological properties of the drugs.
Collapse
Affiliation(s)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano-Bozen, Italy.
| |
Collapse
|
14
|
Benedetti GM, Guerriero RM, Press CA. Review of Noninvasive Neuromonitoring Modalities in Children II: EEG, qEEG. Neurocrit Care 2023; 39:618-638. [PMID: 36949358 PMCID: PMC10033183 DOI: 10.1007/s12028-023-01686-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/30/2023] [Indexed: 03/24/2023]
Abstract
Critically ill children with acute neurologic dysfunction are at risk for a variety of complications that can be detected by noninvasive bedside neuromonitoring. Continuous electroencephalography (cEEG) is the most widely available and utilized form of neuromonitoring in the pediatric intensive care unit. In this article, we review the role of cEEG and the emerging role of quantitative EEG (qEEG) in this patient population. cEEG has long been established as the gold standard for detecting seizures in critically ill children and assessing treatment response, and its role in background assessment and neuroprognostication after brain injury is also discussed. We explore the emerging utility of both cEEG and qEEG as biomarkers of degree of cerebral dysfunction after specific injuries and their ability to detect both neurologic deterioration and improvement.
Collapse
Affiliation(s)
- Giulia M Benedetti
- Division of Pediatric Neurology, Department of Neurology, Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, WA, USA.
- Division of Pediatric Neurology, Department of Pediatrics, C.S. Mott Children's Hospital and the University of Michigan, 1540 E Hospital Drive, Ann Arbor, MI, 48109-4279, USA.
| | - Rejéan M Guerriero
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Craig A Press
- Departments of Neurology and Pediatric, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
15
|
Freiman S, Hauser WA, Rider F, Yaroslavskaya S, Sazina O, Vladimirova E, Kaimovsky I, Shpak A, Gulyaeva N, Guekht A. Post-stroke seizures, epilepsy, and mortality in a prospective hospital-based study. Front Neurol 2023; 14:1273270. [PMID: 38107633 PMCID: PMC10722584 DOI: 10.3389/fneur.2023.1273270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Background and objectives Post-stroke epilepsy (PSE) is a significant concern in the elderly population, with stroke being a leading cause of epilepsy in this demographic. Several factors have shown consistent associations with the risk of developing PSE, including cortical lesions, initial stroke severity, younger age, and the occurrence of early seizures. The primary objectives of this study were two-fold: (1) to determine the incidence of PSE and (2) to identify the risk factors associated with PSE in a prospective cohort of post-stroke patients. Methods A prospective single-hospital study was conducted, involving patients diagnosed with acute ischemic and hemorrhagic stroke. The patients were followed up for 2 years (or until death) from the time of admission. Data about seizure occurrence and recurrent stroke were collected. Kaplan-Meyer curves were used for the assessment of PSE incidence and mortality. Possible predictors of PSE and mortality were selected from between-group analysis and tested in multivariable regressions. Results Our study enrolled a total of 424 patients diagnosed with acute stroke. Among them, 97 cases (23%) experienced early post-stroke seizures, and 28 patients (6.6%) developed PSE. The cumulative risks of developing PSE were found to be 15.4% after hemorrhagic stroke and 8.7% after ischemic stroke. In multivariable fine and gray regression with competitive risk of death, significant predictors for developing PSE in the ischemic cohort were watershed infarction (HR 6.01, 95% CI 2.29-15.77, p < 0.001) and low Barthel index at discharge (HR 0.98, CI 0.96-0.99, p = 0.04). Furthermore, patients who eventually developed PSE showed slower recovery and presented a worse neurologic status at the time of discharge. The in-hospital dynamics of the National Institutes of Health Stroke Scale (NIHSS) were significantly worse in the PSE group compared to the non-PSE group (p = 0.01). Discussion A higher proportion of cases experienced early seizures compared to what has been commonly reported in similar studies. Watershed stroke and low Barthel index at discharge were both identified as independent risk factors of PSE in ischemic strokes, which sheds light on the underlying mechanisms that may predispose individuals to post-stroke epilepsy after experiencing an ischemic stroke.
Collapse
Affiliation(s)
- Sofia Freiman
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russia
- Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - W. Allen Hauser
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, New York, NY, United States
| | - Flora Rider
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russia
| | - Sofia Yaroslavskaya
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russia
| | - Olga Sazina
- Buyanov City Hospital of the Healthcare Department of Moscow, Moscow, Russia
| | - Elena Vladimirova
- Konchalovsky City Hospital of the Healthcare Department of Moscow, Moscow, Russia
| | - Igor Kaimovsky
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russia
- Buyanov City Hospital of the Healthcare Department of Moscow, Moscow, Russia
| | - Alexander Shpak
- The Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - Natalia Gulyaeva
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russia
- Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russia
- Buyanov City Hospital of the Healthcare Department of Moscow, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
16
|
Gruber J, Gattringer T, Mayr G, Schwarzenhofer D, Kneihsl M, Wagner J, Sonnberger M, Deutschmann H, Haidegger M, Fandler-Höfler S, Ropele S, Enzinger C, von Oertzen T. Frequency and predictors of poststroke epilepsy after mechanical thrombectomy for large vessel occlusion stroke: results from a multicenter cohort study. J Neurol 2023; 270:6064-6070. [PMID: 37658859 PMCID: PMC10632247 DOI: 10.1007/s00415-023-11966-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Poststroke epilepsy (PSE) represents an important complication of stroke. Data regarding the frequency and predictors of PSE in patients with large-vessel occlusion stroke receiving mechanical thrombectomy (MT) are scarce. Furthermore, information on acute and preexisting lesion characteristics on brain MRI has not yet been systematically considered in risk prediction of PSE. This study thus aims to assess PSE risk after acute ischemic stroke treated with MT, based on clinical and MRI features. METHODS In this multicenter study from two tertiary stroke centers, we included consecutive acute ischemic stroke patients who had received MT for acute intracranial large vessel occlusion (LVO) between 2011 and 2017, in whom post-interventional brain MRI and long term-follow-up data were available. Infarct size, affected cerebrovascular territory, hemorrhagic complications and chronic cerebrovascular disease features were assessed on MRI (blinded to clinical information). The primary outcome was the occurrence of PSE (> 7 days after stroke onset) assessed by systematic follow-up via phone interview or electronic records. RESULTS Our final study cohort comprised 348 thrombectomy patients (median age: 67 years, 45% women) with a median long-term follow-up of 78 months (range 0-125). 32 patients (9%) developed PSE after a median of 477 days (range 9-2577 days). In univariable analyses, larger postinterventional infarct size, infarct location in the parietal, frontal or temporal lobes and cerebral microbleeds were associated with PSE. Multivariable Cox regression analysis confirmed larger infarct size (HR 3.49; 95% CI 1.67-7.30) and presence of cerebral microbleeds (HR 2.56; 95% CI 1.18-5.56) as independent predictors of PSE. CONCLUSION In our study, patients with large vessel occlusion stroke receiving MT had a 9% prevalence of PSE over a median follow-up period of 6.5 years. Besides larger infarct size, presence of cerebral microbleeds on brain MRI predicted PSE occurrence.
Collapse
Affiliation(s)
- Joachim Gruber
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria.
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
| | - Georg Mayr
- Department of Neuroradiology, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Daniel Schwarzenhofer
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Judith Wagner
- Department of Neurology, Evangelisches Klinikum Gelsenkirchen, Academic Hospital University Essen-Duisburg, Gelsenkirchen, Germany
| | - Michael Sonnberger
- Department of Neuroradiology, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Melanie Haidegger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Simon Fandler-Höfler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Tim von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg-Weg 15, 4020, Linz, Austria.
| |
Collapse
|
17
|
Chen YS, Sung PS, Lai MC, Huang CW. The Primary Prevention of Poststroke Epilepsy in Patients With Middle Cerebral Artery Infarct: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49412. [PMID: 37999939 DOI: 10.2196/49412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Poststroke epilepsy poses a significant clinical challenge for individuals recovering from strokes, leading to a less favorable long-term outlook and increased mortality rates. Existing studies have primarily concentrated on administering antiseizure or anticonvulsant treatments only after the onset of late-onset seizures, without intervening during the epileptogenesis phase following a stroke. OBJECTIVE This research protocol is designed to conduct a randomized controlled trial to assess whether the early, preventive introduction of low-dose antiepileptic drug therapy (levetiracetam [LEV] or perampanel [PER]) in patients who have experienced middle cerebral artery (MCA) infarction can reduce the risk of developing poststroke epilepsy (primary prevention). METHODS Participants with MCA infarction, either with or without reperfusion treatments, will be recruited and promptly receive preventive intervention within 72 hours of the stroke occurrence. These participants will be randomly assigned to receive either PER (4 mg per day), LEV (1000 mg per day), or a placebo that matches the active drugs. This treatment will continue for 12 weeks after allocation. Brain magnetic resonance imaging will be used to confirm the presence of MCA territory infarction, and an electroencephalography will be used to ensure the absence of epileptiform discharges or electrographic seizures at the time of the stroke. All participants will undergo follow-up assessments for 72 weeks after allocation. RESULTS The primary outcome under evaluation will be the incidence of poststroke epilepsy in the 3 groups following the 18-month study period. Secondary outcomes will encompass the time to the occurrence of the first seizure, the severity of seizures, any treatment-related adverse events, and the modified Rankin scale score at 3 and 18 months. Exploratory outcomes will involve comparing the effectiveness and safety of PER and LEV. CONCLUSIONS We anticipate that the intervention groups will experience a lower incidence and reduced severity of poststroke epilepsy compared to the control group after 18 months. We aim to establish evidence supporting the potential preventive effects of LEV and PER on poststroke seizures and epilepsy in patients with MCA infarction, as well as to explore the antiepileptogenic potential of both LEV and PER in patients with major ischemic strokes. TRIAL REGISTRATION ClinicalTrials.gov NCT04858841; https://clinicaltrials.gov/study/NCT04858841. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49412.
Collapse
Affiliation(s)
- Yu-Shiue Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Chi Lai
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
18
|
Migdady I, Johnson-Black PH, Leslie-Mazwi T, Malhotra R. Current and Emerging Endovascular and Neurocritical Care Management Strategies in Large-Core Ischemic Stroke. J Clin Med 2023; 12:6641. [PMID: 37892779 PMCID: PMC10607145 DOI: 10.3390/jcm12206641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The volume of infarcted tissue in patients with ischemic stroke is consistently associated with increased morbidity and mortality. Initial studies of endovascular thrombectomy for large-vessel occlusion excluded patients with established large-core infarcts, even when large volumes of salvageable brain tissue were present, due to the high risk of hemorrhagic transformation and reperfusion injury. However, recent retrospective and prospective studies have shown improved outcomes with endovascular thrombectomy, and several clinical trials were recently published to evaluate the efficacy of endovascular management of patients presenting with large-core infarcts. With or without thrombectomy, patients with large-core infarcts remain at high risk of in-hospital complications such as hemorrhagic transformation, malignant cerebral edema, seizures, and others. Expert neurocritical care management is necessary to optimize blood pressure control, mitigate secondary brain injury, manage cerebral edema and elevated intracranial pressure, and implement various neuroprotective measures. Herein, we present an overview of the current and emerging evidence pertaining to endovascular treatment for large-core infarcts, recent advances in neurocritical care strategies, and their impact on optimizing patient outcomes.
Collapse
Affiliation(s)
- Ibrahim Migdady
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Phoebe H. Johnson-Black
- Department of Neurosurgery, Division of Neurocritical Care, UCLA David Geffen School of Medicine, Ronald Reagan Medical Center, Los Angeles, CA 90095, USA;
| | | | - Rishi Malhotra
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| |
Collapse
|
19
|
Fu L, Yu B, Lv B, Tian Y, Zhang Y, Chen H, Yang S, Hu Y, Ren P, Li J, Gong S. Negative regulation of angiogenesis and the MAPK pathway may be a shared biological pathway between IS and epilepsy. PLoS One 2023; 18:e0286426. [PMID: 37792772 PMCID: PMC10550183 DOI: 10.1371/journal.pone.0286426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/16/2023] [Indexed: 10/06/2023] Open
Abstract
Ischemia stroke and epilepsy are two neurological diseases that have significant patient and societal burden, with similar symptoms of neurological deficits. However, the underlying mechanism of their co-morbidity are still unclear. In this study, we performed a combined analysis of six gene expression profiles (GSE58294, GSE22255, GSE143272, GSE88723, GSE163654, and GSE174574) to reveal the common mechanisms of IS and epilepsy. In the mouse datasets, 74 genes were co-upregulated and 7 genes were co-downregulated in the stroke and epilepsy groups. Further analysis revealed that the co-expressed differentially expressed genes (DEGs) were involved in negative regulation of angiogenesis and the MAPK signaling pathway, and this was verified by Gene Set Enrichment Analysis of human datasets and single cell RNA sequence of middle cerebral artery occlusion mice. In addition, combining DEGs of human and mouse, PTGS2, TMCC3, KCNJ2, and GADD45B were identified as cross species conserved hub genes. Meanwhile, molecular docking results revealed that trichostatin A and valproic acid may be potential therapeutic drugs. In conclusion, to our best knowledge, this study conducted the first comorbidity analysis of epilepsy and ischemic stroke to identify the potential common pathogenic mechanisms and drugs. The findings may provide an important reference for the further studies on post-stroke epilepsy.
Collapse
Affiliation(s)
- Longhui Fu
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Beibei Yu
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Boqiang Lv
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Yunze Tian
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Yongfeng Zhang
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Huangtao Chen
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Shijie Yang
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Yutian Hu
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Pengyu Ren
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Jianzhong Li
- Department of Thoracic Surgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
| | - Shouping Gong
- Department of Neurourgery, Second Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
- Xi’an Medical University, Xi’an, China
| |
Collapse
|
20
|
Tsukada T, Masuoka T, Kubo M. A case of temporary occlusion of donor artery after secondary generalized seizure in a patient with superficial temporal artery-middle cerebral artery bypass. Surg Neurol Int 2023; 14:330. [PMID: 37810288 PMCID: PMC10559387 DOI: 10.25259/sni_612_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background To prevent stroke recurrence, a superficial temporal artery-middle cerebral artery (STA-MCA) bypass for atherosclerotic cerebrovascular occlusive disease is performed. Post stroke epilepsy is known as serious sequelae of stroke. Herein, we present a case of a 60-year-old man who underwent STA-MCA bypass for the prevention of stroke recurrence; however, the donor artery was deemed to be temporally occluded secondary to generalized seizure. Case Description A 60-year-old man was referred to our hospital with a diagnosis of the left cervical internal carotid artery occlusion presenting with mild aphasia and right hemiparesis. He underwent STA-MCA bypass to prevent the recurrence of stroke 1 month after the onset of symptoms. On postoperative day 7, patency of the donor artery was confirmed on magnetic resonance imaging (MRI), and no complications were noted. However, on postoperative day 14, he presented with a secondary generalized seizure. MRI was immediately performed and the donor artery was not patent with no new lesions. Several hours thereafter, the blood flow of the donor artery was confirmed using pulse Doppler; however, during mouth opening, the flow of the donor artery decreased. Computed tomography-angiography confirmed donor artery patency. An encephalogram was conducted and revealed a focal epilepsy which was compatible with stroke on MRI. Conclusion Post stroke epilepsy caused an unintended and forced mouth opening which led to a temporary occlusion of the donor artery after STA-MCA bypass. Thus, this complication should be recognized, and seizures should be prevented through the administration of prophylactic anti-seizure medication based on risk stratification assessment of post stroke epilepsy.
Collapse
Affiliation(s)
- Tsuyoshi Tsukada
- Department of Neurosurgery, Saiseikai Toyama Hospital, Toyama, Japan
| | - Toru Masuoka
- Department of Neurosurgery, Tonami General Hospital, Toyama, Japan
| | - Michiya Kubo
- Department of Neurosurgery, Saiseikai Toyama Hospital, Toyama, Japan
| |
Collapse
|
21
|
Samake B, Houot M, Zavanone C, Vassilev K, Thivard L, Herlin B, Dupont S. Late but not early seizures impact negatively early post stroke recovery: A case-control study. Eur Stroke J 2023; 8:784-791. [PMID: 37329139 PMCID: PMC10472947 DOI: 10.1177/23969873231182493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Seizures are a frequent complication of strokes. The initial severity of the stroke is a risk factor for both seizure occurrence and poor functional recovery. AIM To determine whether epilepsy has a negative impact on functional recovery or is just a proxy for the initial severity of the stroke. PATIENTS AND METHODS We conducted a monocentric retrospective case-control study in 408 consecutive patients hospitalized in the neurological rehabilitation department of the Pitié-Salpêtrière Hospital for rehabilitation of a recent stroke between 1999 and 2019. We matched 1:1 stroke patients with and without seizures according to numerous variables that may influence the outcome: type of stroke (ischemic vs hemorrhagic (ICH)), type of endovascular treatment performed (thrombolysis, thrombectomy), exact location of the stroke (arterial territory for ischemic strokes, lobar territory for ICH), extent of the stroke, side of the stroke, and age at the time of stroke. Two criteria were used to judge the impact on neurological recovery: the change in modified Rankin score between entry and the discharge from the rehabilitation department, and the length of stay. Seizures were divided into early (within 7 days of stroke) and late (after 7 days) seizures. RESULTS We accurately matched 110 stroke patients with and without seizures. Compared to seizure-free matched stroke patients, stroke patients with late seizures had a poorer neurological functional recovery in terms of Rankin score evolution (p = 0.011*) and length of stay (p = 0.004*). The occurrence of early seizures had no significant impact on functional recovery criteria. CONCLUSION Late seizures, that is, stroke-related epilepsy, have a negative impact on early rehabilitation, whereas early symptomatic seizures do not negatively impact functional recovery. These results reinforce the recommendation not to treat early seizures.
Collapse
Affiliation(s)
- Bakary Samake
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marion Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Memory and Alzheimer’s Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital, Paris, France
| | - Chiara Zavanone
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Kosta Vassilev
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Lionel Thivard
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Bastien Herlin
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Sophie Dupont
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, Paris, France
- Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
22
|
Šmigelskytė A, Gelžinienė G, Jurkevičienė G. Early Epileptic Seizures after Ischemic Stroke: Their Association with Stroke Risk Factors and Stroke Characteristics. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1433. [PMID: 37629723 PMCID: PMC10456278 DOI: 10.3390/medicina59081433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: A growing number of stroke survivors face various stroke complications, including new-onset epileptic seizures (ESs). Post-stroke ESs are divided into early and late ESs based on the time of onset after stroke. Early ESs are associated with worse stroke outcomes, longer hospitalization and an increased risk of late ESs. A variety of risk factors for early ESs are being studied in order to prevent their occurrence. Therefore, we aim to determine the association of early ESs with ischemic stroke risk factors and characteristics. Materials and Methods: A total of 166 patients, treated for ischemic stroke in the Hospital of Lithuanian University of Health Sciences Kaunas Clinics, were enrolled in a prospective cohort study. Initially, data about stroke risk factors, localization, severity and treatment were collected, followed by an observation period of 14 days for early ESs. Results: Early ESs occurred in 11 (6.6%) participants. The probability of early ESs after ischemic stroke among males and females (LogRank = 1.281; p > 0.05), younger (≤65 y) and older (>65 y) participants (LogRank = 0.129; p > 0.05) was the same. The presence of ischemic stroke risk factors, such as atrial fibrillation (LogRank = 0.004; p > 0.05), diabetes mellitus (LogRank = 1.168; p > 0.05) and dyslipidemia (LogRank = 0.092; p > 0.05), did not increase the probability of early ESs. However, participants without a prior history of arterial hypertension (LogRank = 4.453; p < 0.05) were more likely to develop early ESs. Stroke localization (anterior versus posterior) (LogRank = 0.011; p > 0.05), stroke severity (LogRank = 0.395; p > 0.05) and type of treatment (specific versus non-specific) (LogRank = 1.783; p > 0.05) did not affect the probability of early ESs.
Collapse
Affiliation(s)
- Agnė Šmigelskytė
- Department of Neurology, Lithuanian University of Health Sciences, A. Mickevičiaus str. 9, LT-44307 Kaunas, Lithuania
| | | | | |
Collapse
|
23
|
Jiang W, Zhu X, Lei C, Jiang G, Zhang L, Mei S, Zhong L. Risk assessment of mechanic thrombectomy on post-stroke seizures: a systematical review and meta-analysis. J Stroke Cerebrovasc Dis 2023; 32:107155. [PMID: 37172469 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE We conducted a systematic review and meta-analysis to evaluate the risk of early and late onset seizures following stroke mechanic thrombectomy (MT) compared with other systematic thrombolytic strategies. METHODS A literature search was conducted to identify articles covering databases (PubMed, Embase, and Cochrane Library) published from 2000 to 2022. The primary outcome was the incidence of post-stroke epilepsy or seizures following MT or in combination with intravenous thrombolytics therapy. Risk of bias was assessed by recording study characteristics. The study was conducted according to the PRISMA guidelines. RESULTS There were 1346 papers in the search results, and 13 papers were included in the final review.We identified 29,793 patients with stroke, of which 695 had seizures. Pooled incidence of post-stroke seizures had no significant difference between mechanic thrombolytic group and other thrombolytic strategy group (OR=0.95 (95%CI= 0.75-1.21); Z=0.43; p=0.67). In subgroup analysis, mechanic group have a lower risk of post-stroke early onset of seizures (OR=0.59 (95%CI=0.36-0.95); Z=2.18; p<0.05) but showed no significant difference in post-stroke late onset of seizures (OR=0.95 (95%CI= 0.68-1.32); Z=0.32; p=0.75). CONCLUSIONS MT may be associated with a lower risk of post-stroke early onset of seizures, despite MT does not affect the pooled incidence of post-stroke seizures compared with other systematic thrombolytic strategies.
Collapse
Affiliation(s)
- Wen Jiang
- Department of Neurology/Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Xiaoyan Zhu
- Department of Neurology/Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Chunyan Lei
- Department of Neurology/Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Guoliang Jiang
- Yunnan Provincial Clinical Research Center for Neurological Disease, Kunming 650032, Yunnan Province, China
| | - Linming Zhang
- Department of Neurology/Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Song Mei
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China.
| | - Lianmei Zhong
- Department of Neurology/Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| |
Collapse
|
24
|
Wei X, Huang G, Liu J, Ge J, Zhang W, Mei Z. An update on the role of Hippo signaling pathway in ischemia-associated central nervous system diseases. Biomed Pharmacother 2023; 162:114619. [PMID: 37004330 DOI: 10.1016/j.biopha.2023.114619] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
The most frequent reason of morbidity and mortality in the world, cerebral ischemia sets off a chain of molecular and cellular pathologies that associated with some central nervous system (CNS) disorders mainly including ischemic stroke, Alzheimer's disease (AD), Parkinson's disease (PD), epilepsy and other CNS diseases. In recent times, despite significant advancements in the treatment of the pathological processes underlying various neurological illnesses, effective therapeutic approaches that are specifically targeted to minimizing the damage of such diseases remain absent. Hippo signaling pathway, characterized by enzyme linked reactions between MSTI/2, LAST1/2, and YAP or TAZ proteins, controls cell division, survival, and differentiation, as well as being engaged in a variety of biological activities, such as the development and transformation of the nervous system. Recently, accumulating studies demonstrated that Hippo pathway takes part in the processes of ischemic stroke, AD, PD, etc., including but not limited to oxidative stress, inflammatory response, blood-brain barrier damage, mitochondrial disorders, and neural cells death. Thus, it's crucial to understand the molecular basis of the Hippo signaling pathway for determining potential new therapeutic targets against ischemia-associated CNS diseases. Here, we discuss latest advances in the deciphering of the Hippo signaling pathway and highlight the therapeutic potential of targeting the pathway in treating ischemia-associated CNS diseases.
Collapse
|
25
|
Winder K, Bobinger T, Seifert F, Mrochen A, Haupenthal D, Knott M, Dörfler A, Hilz MJ, Schwab S, Fröhlich K. Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy. J Neuroimaging 2023. [PMID: 37129978 DOI: 10.1111/jon.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND AND PURPOSE The relationship between ischemic stroke site and occurrence of poststroke epilepsy (PSE) is incompletely understood. This study intended to evaluate incidence and temporal profiles of seizures and to correlate ischemic lesion sites with PSE using voxel-based lesion symptom mapping (VLSM). METHODS Patients with imaging-confirmed first-ever ischemic stroke without prior history of epilepsy were prospectively included. Demographic data, cardiovascular risk factors, and National Institute of Health Stroke Scale (NIHSS) scores were assessed. Data on seizures and modified Rankin scale scores were determined within a 90-day period after stroke onset. Ischemic lesion sites were correlated voxel wise with occurrence of PSE using nonparametric permutation test. Age- and sex-matched patients with first-ever ischemic strokes without PSE after 90 days served as controls for the VLSM analysis. RESULTS The stroke database contained 809 patients (mean age: 68.4 ± 14.2 years) with first-ever imaging-confirmed ischemic strokes without history of epilep. Incidence of PSE after 90-day follow-up was 2.8%. Five additional patients were admitted to the emergency department with a seizure after 90-day follow-up. Fifty percent of the seizures occurred in the acute phase after stroke. PSE patients had higher NIHSS scores and infarct volumes compared to controls without PSE (p < .05). PSE patients had infarcts predominantly involving the cerebral cortex. The hemisphere-specific VLSM analysis shows associations between PSE and damaged voxels in the left-hemispheric temporo-occipital transition zone. CONCLUSIONS The data indicate that PSE occurs in a small proportion of patients with rather large ischemic strokes predominantly involving the cerebral cortex. Especially patients with ischemic lesions in the temporo-occipital cortex are vulnerable to develop PSE.
Collapse
Affiliation(s)
- Klemens Winder
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
- Department of Neurology and Stroke Center, Klinik Hirslanden, Zürich, Switzerland
| | - Tobias Bobinger
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Frank Seifert
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Anne Mrochen
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - David Haupenthal
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Michael Knott
- Department of Neuroradiology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Max J Hilz
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Kilian Fröhlich
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
26
|
Mangiardi M, Iaccarino G, Alessiani M, Bonura A, Anticoli S. Treating Post-stroke Epilepsy in a Patient With Multiple Comorbidities. Cureus 2023; 15:e38483. [PMID: 37273407 PMCID: PMC10237253 DOI: 10.7759/cureus.38483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Stroke is a major cause of seizures and epilepsy in adults. Stroke severity, younger age, hemorrhagic subtype of stroke, and alcohol use have been identified as risk factors for the development of stroke-related epilepsy. Despite being a common complication in stroke survivors, current guidelines do not provide strong recommendations about the optimal treatment of post-stroke seizures. No clear guidance is given about the preferred antiseizure medications (ASMs), primary and secondary prophylaxis, and ASMs withdrawal. The management of older patients is further complicated by the presence of comorbidities, pharmacokinetic alterations, and intake of several medications. We present a case of a 77-year-old man affected by epidermolysis bullosa and diabetes mellitus, who suffered from ischemic stroke and then developed post-stroke seizures. This case shows how complex it is to manage post-stroke seizures in an older patient with multiple comorbidities.
Collapse
Affiliation(s)
| | - Gianmarco Iaccarino
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, ITA
| | - Michele Alessiani
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, ITA
| | - Adriano Bonura
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, ITA
| | - Sabrina Anticoli
- Stroke Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, ITA
| |
Collapse
|
27
|
Yonas AS, Meschia JF, Feyissa AM. Clinical Biomarkers and Prediction Models for Poststroke Epilepsy: Have We Settled the Scores Yet? Neurol Clin Pract 2023; 13:e200146. [PMID: 36936392 PMCID: PMC10022724 DOI: 10.1212/cpj.0000000000200146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/12/2023] [Indexed: 03/15/2023]
Abstract
In an era of time-dependent reperfusion and recanalization therapy for stroke leading to improved survival, there is a growing population at risk of poststroke epilepsy (PSE). Accumulating evidence suggests a multidirectional interaction among stroke, PSE, and dementia in stroke survivors. There is no evidence to justify prophylactic antiseizure medication (ASM) to reduce these morbidities. Although several predictive molecular biomarkers and scoring models have been proposed, they remain inadequately validated for stratifying risk and indicating who will benefit from prophylactic ASM. Studies leveraging advances in genetics, metabolomics, electrophysiology, imaging, and artificial intelligence (AI) may help to discover noninvasive molecular biomarkers and easy-to-score models. These discoveries should improve our understanding of epileptogenesis in PSE and identify new pharmacologic targets. Besides, accurately identifying high-risk patients and timely initiating prophylactic ASM therapy has the potential to disrupt the feed-forward multidirectional interaction among stroke, PSE, and dementia.
Collapse
Affiliation(s)
- Amen S Yonas
- Department of Neurology (ASY, JFM, AMF), Mayo Clinic, Jacksonville, FL
| | - James F Meschia
- Department of Neurology (ASY, JFM, AMF), Mayo Clinic, Jacksonville, FL
| | - Anteneh M Feyissa
- Department of Neurology (ASY, JFM, AMF), Mayo Clinic, Jacksonville, FL
| |
Collapse
|
28
|
Lasek-Bal A, Dewerenda-Sikora M, Binek Ł, Student S, Łabuz-Roszak B, Krzystanek E, Kaczmarczyk A, Krzan A, Żak A, Cieślik A, Bosak M. Epileptiform activity in the acute phase of stroke predicts the outcomes in patients without seizures. Front Neurol 2023; 14:1096876. [PMID: 36994378 PMCID: PMC10040780 DOI: 10.3389/fneur.2023.1096876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Background and purposeThe abnormalities in EEG of stroke-patients increase the risk of epilepsy but their significancy for poststroke outcome is unclear. This presented study was aimed at determining the prevalence and nature of changes in EEG recordings from the stroke hemisphere and from the contralateral hemisphere. Another objective was to determine the significance of abnormalities in EEG in the first days of stroke for the post-stroke functional status on the acute and chronic phase of disease.MethodsIn all qualified stroke-patients, EEG was performed during the first 3 days of hospitalization and at discharge. The correlation between EEG abnormalities both in the stroke hemisphere and in the collateral hemisphere with the neurological and functional state in various time points was performed.ResultsOne hundred thirty-one patients were enrolled to this study. Fifty-eight patients (44.27%) had abnormal EEG. The sporadic discharges and generalized rhythmic delta activity were the most common abnormalities in the EEG. The neurological status on the first day and the absence of changes in the EEG in the hemisphere without stroke were the independent factors for good neurological state (0–2 mRS) at discharge. The age-based analysis model (OR 0.981 CI 95% 0.959–1.001, p = 0.047), neurological status on day 1 (OR 0.884 CI 95% 0.82–0.942, p < 0.0001) and EEG recording above the healthy hemisphere (OR 0.607 CI 95% 0.37–0.917, p = 0.028) had the highest prognostic value in terms of achieving good status 90 days after stroke.ConclusionsAbnormalities in EEG without clinical manifestation are present in 40% of patients with acute stroke. Changes in EEG in acute stroke are associated with a poor neurological status in the first days and poor functional status in the chronic period of stroke.
Collapse
Affiliation(s)
- Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
- *Correspondence: Anetta Lasek-Bal
| | - Milena Dewerenda-Sikora
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Łukasz Binek
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Sebastian Student
- Faculty of Automatic Control Electronics and Computer Science, Silesian University of Technology, Gliwice, Poland
- Biotechnology Center, Silesian University of Technology, Gliwice, Poland
| | - Beata Łabuz-Roszak
- Department of Neurology, Institute of Medical Sciences University of Opole, Opole, Poland
| | - Ewa Krzystanek
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Aleksandra Kaczmarczyk
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Krzan
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Amadeusz Żak
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Aleksandra Cieślik
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Magdalena Bosak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
29
|
Punia V, Li Y, Lapin B, Chandan P, Newey C, Hantus S, Dhakar M, Rubinos C, Zafar S, Sivaraju A, Katzan IL. Impact of acute symptomatic seizures and their management on patient-reported outcomes after stroke. Epilepsy Behav 2023; 140:109115. [PMID: 36804847 DOI: 10.1016/j.yebeh.2023.109115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Acute symptomatic seizures (ASyS) after stroke are not uncommon. However, the impact of ASyS and its management with anti-seizure medications (ASMs) on patient-reported outcome measures (PROMs) remains poorly investigated. The objective of our study is to evaluate the association between PROMs and ASyS and ASMs following stroke. METHODS We performed a retrospective cohort study of all stroke patients who underwent inpatient continuous EEG (cEEG) monitoring performed due to suspected ASyS, including the ones with observed convulsive ASyS, from 04/01/2012 to 03/31/2018, who completed PROMs within 6 months of hospital discharge. Patient-reported outcome measures, including one Neuro-QoL and six PROMIS v1.0 domain scales, were completed by patients as the standard of care in ambulatory stroke clinics. Since ASMs are sometimes used without clearly diagnosed ASyS, we performed group comparisons based on ASM status at discharge, irrespective of their ASyS status. T-tests or Wilcoxon rank sum tests compared continuous variables across groups and chi-square tests or Fisher's exact tests were used for categorical variables. RESULTS A total of 508 patients were included in the study [mean age 62.0 ± 14.1 years, 51.6% female; 244 (48.0%) ischemic stroke, 165 (32.5%) intracerebral hemorrhage, and 99 (19.5%) subarachnoid hemorrhage]. A total of 190 (37.4%) patients were discharged on ASMs. At the time of the first PROM, conducted a median of 47 (IQR = 33-78) days after the suspected ASyS, and 162 (31.9%) were on ASMs. ASM use was significantly higher in patients diagnosed with ASyS. Physical Function and Satisfaction with Social Roles and Activities were the most affected health domains. Patient-reported outcome measures were not significantly different between groups based on ASyS (electrographic and/or convulsive), ASM use at hospital discharge, or ASM status on the day of PROM completion. SIGNIFICANCE There were no differences in multiple domain-specific PROMs in patients with recent stroke according to ASyS status or ASM use suggesting the possible lack of the former's sensitivity to detect their impact. Additional research is necessary to determine if there is a need for developing ASyS-specific PROMs.
Collapse
Affiliation(s)
- Vineet Punia
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Yadi Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Pradeep Chandan
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Christopher Newey
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States; Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Stephen Hantus
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Monika Dhakar
- Rhode Island Hospital, Brown University, United States
| | - Clio Rubinos
- University of North Carolina, Chapel Hill, United States
| | - Sahar Zafar
- Massachusetts General Hospital, Harvard University, United States
| | | | - Irene L Katzan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | | |
Collapse
|
30
|
Tabaee Damavandi P, Storti B, Fabin N, Bianchi E, Ferrarese C, DiFrancesco JC. Epilepsy in cerebral amyloid angiopathy: an observational retrospective study of a large population. Epilepsia 2023; 64:500-510. [PMID: 36515439 DOI: 10.1111/epi.17489] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cerebral amyloid angiopathy (CAA) is a major cause of spontaneous intracranial hemorrhage in older adults. Epilepsy represents a possible sequela of the disease. To date, studies on epilepsy in CAA are lacking, and the few data available mainly focus on CAA-related inflammation (CAA-ri), the inflammatory form of the disease. METHODS In this retrospective observational study, we consecutively recruited CAA patients observed over a time span of 10 years, collecting demographic, clinical, and instrumental data. Significant baseline characteristics were evaluated as potential risk factors for the development of epilepsy in the CAA population, and in the subgroups of CAA-ri and CAA without inflammatory reaction (CAA-nri). The effect of potential risk factors for epilepsy was measured as odds ratio with 95% confidence interval. RESULTS Within 96 recruited CAA cases, 33 (34.4%) developed epilepsy during follow-up (median = 13.5 months). The prevalent type of seizure was focal (81.3%); 12.1% of the epileptic patients presented status epilepticus, and 6.1% developed drug-resistant epilepsy. Electroencephalographic traces revealed slow and epileptic discharge activity in the majority of epileptic patients, but also in those without epilepsy. The presence of focal or disseminated cortical superficial siderosis (cSS) was associated with an increased risk of epilepsy in the CAA-nri group, and the association with CAA-ri and epilepsy was present in the overall population. SIGNIFICANCE Epilepsy is a common manifestation during the course of CAA, where CAA-ri and cSS represent predisposing factors for the development of seizures. These data suggest the importance of a deep characterization of CAA patients, to better select those more prone to develop epilepsy.
Collapse
Affiliation(s)
- Payam Tabaee Damavandi
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| | - Benedetta Storti
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| | - Natalia Fabin
- Laboratory of Epidemiological and Clinical Cardiology, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Elisa Bianchi
- Neurological Disorders, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Carlo Ferrarese
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, ASST San Gerardo Hospital, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milan-Bicocca, Monza, Italy
| |
Collapse
|
31
|
Eriksson H, Nordanstig A, Rentzos A, Zelano J, Redfors P. Risk of poststroke epilepsy after reperfusion therapies: A national cohort study. Eur J Neurol 2023; 30:1303-1311. [PMID: 36692236 DOI: 10.1111/ene.15695] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE The risk of poststroke epilepsy (PSE) after endovascular treatment (EVT) is not well characterized. In this nationwide study, we assessed the risk of PSE after EVT and identified associated predictors. METHODS We included all individuals (n = 3319) treated with EVT (±intravenous thrombolysis [IVT]) between 2015 and 2019 in the Swedish National Quality Register for EVT. Two control groups were identified from the Swedish Stroke Register: the first treated with IVT alone (n = 3132) and the second with no treatment (n = 3184), both matched for age, sex, stroke severity, and time of stroke. RESULTS PSE developed in 7.9% (n = 410). The survival-adjusted 2-year risk was 6.5% (95% confidence interval [CI] = 5.28-7.70) after EVT, 10.0% (95% CI = 8.25-11.75) after IVT, and 12.3% after no revascularization (95% CI = 10.33-14.25). The hazard ratio (HR) of PSE after EVT was almost half compared to no treatment (HR = 0.51, 95% CI = 0.41-0.64). The risk of PSE after EVT was lower compared to no treatment in a multivariable Cox model that adjusted for age, sex, hemicraniectomy, and stroke severity (HR = 0.76, 95% CI = 0.60-0.96). Multivariable predictors of PSE after EVT were large infarction on computed tomography Day 1, high posttreatment National Institutes of Health Stroke Scale score, and need of assistance 3 months after stroke. IVT before EVT was associated with a lower risk of PSE (HR = 0.66, 95% CI = 0.46-0.94). CONCLUSIONS This nationwide study identified a reduced risk of PSE after EVT. Markers of severe infarction after EVT were associated with PSE, whereas IVT given before EVT was protective.
Collapse
Affiliation(s)
- Hanna Eriksson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Annika Nordanstig
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alexandros Rentzos
- Department of Interventional and Diagnostic Neuroradiology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Zelano
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
32
|
Nilo A, Pauletto G, Lorenzut S, Merlino G, Verriello L, Janes F, Bax F, Gigli GL, Valente M. Post-Stroke Status Epilepticus: Time of Occurrence May Be the Difference? J Clin Med 2023; 12:jcm12030769. [PMID: 36769417 PMCID: PMC9918271 DOI: 10.3390/jcm12030769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
(1) Background: Stroke is one of the most frequent causes of status epilepticus (SE) in adults. Patients with stroke and SE have poorer prognosis than those with stroke alone. We described characteristics and prognosis of early- and late-onset post-stroke SE (PSSE). (2) Methods: We retrospectively analyzed consecutive stroke patients who experienced a first SE between August 2012 and April 2021, comparing clinical characteristics, stroke, and SE features between early- versus late-onset SE in relation to patients' outcome. (3) Results: Forty stroke patients experienced PSSE. Fourteen developed an early-onset SE (35%) and twenty-six a late-onset SE (65%). Early-onset SE patients had a slightly higher NIHSS score at admission (6.9 vs. 6.0; p = 0.05). Early-onset SE was more severe than late-onset, according to STESS (Status Epilepticus Severity Score) (3.5 vs. 2.8; p = 0.05) and EMSE (Epidemiology-based Mortality score in Status Epilepticus) score (97.0 vs. 69.5; p = 0.04); furthermore, it had a significant impact on disability at 3-month and 1-year follow-up (p = 0.03 and p = 0.02). SE recurrence and seizures relapse were observed mainly in cases of late-onset SE. (4) Conclusions: Early-onset SE seems to be associated with higher disability in short- and long-term follow-up as possible expression of severe acute brain damage.
Collapse
Affiliation(s)
- Annacarmen Nilo
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
- Correspondence:
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Simone Lorenzut
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Giovanni Merlino
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Lorenzo Verriello
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Francesco Janes
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Francesco Bax
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine Medical School, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
- Department of Medicine (DAME), University of Udine Medical School, 33100 Udine, Italy
| |
Collapse
|
33
|
Liu F, Chen D, Fu Y, Wang H, Liu L. Incidence and association of seizures in stroke patients following endovascular treatment: A systematic review and meta-analysis. Eur J Neurol 2023; 30:134-143. [PMID: 36094786 DOI: 10.1111/ene.15564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Post-stroke seizures (PSSs) are some of the most common complications of stroke and are associated with poor outcomes in patients. Endovascular treatment (EVT) is the standard of care for patients with acute ischaemic stroke related large-vessel occlusion. However, whether EVT increases the risk of PSSs remains controversial; the association between PSSs and EVT is poorly understood. METHODS PubMed, Embase and the Cochrane Library were searched for relevant studies published from 1995 to 6 December 2021. The overall incidence of PSSs in patients treated with EVT and the separate incidence for all included studies in each subgroup, stratified by the type of treatment or time of onset, were calculated. The pooled odds ratio and confidence interval were calculated to quantify the effects of EVT on PSS occurrence. RESULTS In all, 946 studies were screened and 16 articles were included, with a total sample size of 12,664 patients; 7836 patients received EVT, of whom 460 had PSS. The pooled incidence of PSS after EVT was 5.8%, which was similar to patients treated with mechanical thrombectomy (5.3%), intra-arterial thrombolysis (6.8%) or bridging therapy (5.4%). The cumulative incidence of post-stroke epilepsy (6.0%) was almost twice that of acute symptomatic seizures (3.6%). The pooled odds ratio for the relationship between EVT and PSS was 1.91 (95% confidence interval 0.98-3.73). CONCLUSIONS The cumulative incidence of stroke patients treated with EVT who developed seizures was 5.8%, and EVT was non-significantly associated with the occurrence of seizures after stroke.
Collapse
Affiliation(s)
- Fangzhou Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoqi Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
34
|
Diagnosis and Treatment of Poststroke Epilepsy: Where Do We Stand? Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00744-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Abstract
Purpose of Review
Stroke is the most common cause of seizures and epilepsy in older adults. This educational paper aims to give an update on current clinical aspects of diagnosis and treatment of poststroke epilepsy.
Recent Findings
Regarding epileptic seizures related to stroke, it is important to distinguish between acute symptomatic seizures and unprovoked seizures as they differ in their risk for seizure recurrence. In fact, after a single unprovoked poststroke seizure, a diagnosis of epilepsy can be made because there is a greater than 60% risk for further seizures. Clinical models that can predict the development of epilepsy after a stroke have been successfully established. However, treatment with anti-seizure medications is advised only after a first unprovoked poststroke seizure, as current treatments are not known to be effective for primary prevention. The management of poststroke epilepsy requires consideration of aspects such as age, drug-drug interactions and secondary vascular prophylaxis, yet evidence for the use of anti-seizure medications specifically in poststroke epilepsy is limited.
Summary
This text reviews the epidemiology and risk factors for poststroke epilepsy, explains the role of EEG and neuroimaging in patients with stroke and seizures and provides an overview on the clinical management of stroke-related acute symptomatic seizures and poststroke epilepsy.
Collapse
|
35
|
Krämer G, Specht U. Driving eligibility for group 1 and 2 licenses after an acute symptomatic seizure due to a structural brain lesion – English Version. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
36
|
Stancu P, De Stefano P, Vargas M, Menetre E, Carrera E, Kleinschmidt A, Seeck M. Acute symptomatic seizures and hippocampal sclerosis: the major contributor for post-stroke epilepsy? J Neurol 2022; 269:5934-5939. [PMID: 35796763 PMCID: PMC9553845 DOI: 10.1007/s00415-022-11254-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Hippocampal sclerosis (HS) is a prominent biomarker of epilepsy. If acquired later in life, it usually occurs in the context of degenerative or acute inflammatory-infectious disease. Conversely, acute symptomatic seizures (ASS) are considered a risk factor for developing post-stroke epilepsy, but other factors remain unrecognized. Here, we hypothesize that silent hippocampal injury contributes to the development of post-stroke epilepsy. METHODS We performed a retrospective observational study of patients hospitalized between 1/2007 and 12/2018 with an acute stroke in the Stroke Center of the Geneva University Hospital. Patients were included if they had a documented normal hippocampal complex at onset and a control MRI at ≥ 2 year interval without new lesion in the meantime. RESULTS 162 patients fulfilled our inclusion criteria. ASS during the first week (p < 0.0001) and epileptiform abnormalities in electroencephalography (EEG; p = 0.02) were more frequently associated with the development of epilepsy. Hemorrhagic stroke was strongly associated to both ASS and future focal epilepsy (p = 0.00097). Three patients (1.8%) developed hippocampal sclerosis ipsilateral to the cerebrovascular event between 2 and 5 years, all with ASS and hemorrhagic stroke. INTERPRETATION ASS and epileptiform EEG abnormalities are strong predictors of post-stroke epilepsy. HS develops in a minority of patients after hemorrhagic lesions, leading to focal epilepsy. Prospective studies are required, including follow-up with EEG and if characterized by epileptiform discharges, with MRI, to determine the true frequency of HS and to better understand predictors of post-stroke epilepsy (AAS, stroke type, and HS), and their impact on stroke recovery.
Collapse
Affiliation(s)
- Patrick Stancu
- Neurology Division, University Hospital of Geneva, Geneva, Switzerland.
- EEG & Epilepsy Unit, Neurology Division, Department of Clinical Neurosciences, Faculty of Medicine, University Hospital, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland.
| | - Pia De Stefano
- Neurology Division, University Hospital of Geneva, Geneva, Switzerland
| | - Maria Vargas
- Neuroradiology Division, University Hospital of Geneva, Geneva, Switzerland
| | - Eric Menetre
- Neurology Division, University Hospital of Geneva, Geneva, Switzerland
| | - Emmanuel Carrera
- Neurology Division, University Hospital of Geneva, Geneva, Switzerland
| | | | - Margitta Seeck
- Neurology Division, University Hospital of Geneva, Geneva, Switzerland
| |
Collapse
|
37
|
Poststroke Seizure and Epilepsy: A Review of Incidence, Risk Factors, Diagnosis, Pathophysiology, and Pharmacological Therapies. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:7692215. [PMCID: PMC9629926 DOI: 10.1155/2022/7692215] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/23/2022] [Accepted: 10/08/2022] [Indexed: 11/18/2022]
Abstract
Stroke is the most common cause of epilepsy and ultimately leads to a decrease in the quality of life of those affected. Ischemic and hemorrhagic strokes can both lead to poststroke epilepsy (PSE). Significant risk factors for PSE include age < 65age less than 65 years, stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), cortical involvement, and genetic factors such as TRPM6 polymorphism. The diagnosis of PSE is made by using imaging modalities, blood biomarkers, and prognostic criteria. Electroencephalography (EEG) is currently the gold standard to diagnose PSE, while new combinations of modalities are being tested to increase diagnostic specificity. This literature review uncovers a newly found mechanism for the pathology of poststroke epilepsy. The pathogenesis of early-onset and late-onset is characterized by sequelae of neuronal cellular hypoxia and disruption of the blood-brain barrier, respectively. Interleukin-6 is responsible for increasing the activity of glial cells, causing gliosis and hyperexcitability of neurons. Epinephrine, high-mobility group protein B1, downregulation of CD32, and upregulation of HLA-DR impact the pathology of poststroke epilepsy by inhibiting the normal neuronal immune response. Decreased levels of neuropeptide Y, a neurotransmitter, act through multiple unique mechanisms, such as inhibiting intracellular Ca2+ accumulation and acting as an anti-inflammatory, also implemented in the worsening progression of poststroke epilepsy. Additionally, CA1 hippocampal resonant neurons that increase theta oscillation are associated with poststroke epilepsy. Hypertensive small vessel disease may also have an implication in the temporal lobe epilepsy by causing occult microinfarctions. Furthermore, this review highlights the potential use of statins as primary prophylaxis against PSE, with multiple studies demonstrating a reduction in incidence using statins alone, statins in combination with antiepileptic drugs (AEDs), and statins with aspirin. The evidence strongly suggests that the second generation AEDs are a superior treatment method for PSE. Data from numerous studies demonstrate their relative lack of significant drug interactions, increased tolerability, and potential superiority in maintaining seizure-free status.
Collapse
|
38
|
D-Penicillamine Reveals the Amelioration of Seizure-Induced Neuronal Injury via Inhibiting Aqp11-Dependent Ferroptosis. Antioxidants (Basel) 2022; 11:antiox11081602. [PMID: 36009321 PMCID: PMC9405105 DOI: 10.3390/antiox11081602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022] Open
Abstract
Repetitive seizures, a common phenomenon in diverse neurologic conditions such as epilepsy, can undoubtedly cause neuronal injury and our prior work reveals that ferroptosis is a contributing factor of neuronal damage post seizure. However, there is no drug available in clinical practice for ameliorating seizure-induced neuronal impairment via targeting ferroptosis. Our present work aimed to explore whether D-penicillamine (DPA), an originally approved drug for treating Wilson’s disease, inhibited neuronal ferroptosis and alleviated seizure-associated brain damage. Our findings revealed that DPA remarkably improved neuronal survival in kainic acid (KA)-treated mouse model. Furthermore, ferroptosis-associated indices including acyl-coA synthetase long chain family member 4 (ACSL4), prostaglandin-endoperoxide synthase 2 (Ptgs2) gene and lipid peroxide (LPO) level were significantly decreased in KA mouse model after DPA treatment. In a ferroptotic cell death model induced by glutamate or erastin, DPA was also validated to evidently suppress neuronal ferroptosis. The results from RNA-seq analysis indicated that Aqp11, a gene coding previously reported channel protein responsible for transporting water and small solutes, was identified as a molecular target by which DPA exerted anti-ferroptotic potential in neurons. The experimental results from in vivo Aqp11 siRNA transfer into the brain also confirmed that knockdown of Aqp11 abrogated the inhibitory effect of seizure-induced ferroptosis after DPA treatment, suggesting that the effects of DPA on ferroptosis process are dependent upon Aqp11. In conclusion, DPA can be repurposed to cure seizure disorders such as epilepsy.
Collapse
|
39
|
Chou CC, Shih YC, Chiu HH, Yu HY, Lee IH, Lin YY, Lee CC, Peng SJ. Strategic infarct location for post-stroke seizure. Neuroimage Clin 2022; 35:103069. [PMID: 35689977 PMCID: PMC9190039 DOI: 10.1016/j.nicl.2022.103069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/12/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
The hot spots of PSS were distributed around the central region of cerebral cortex. We observed differences between the distribution of hot spots among patients with early-PSS and those with late-PSS. The specific regions of the brain are significantly associated with the development of PSS after cerebral infarction. The location of infarction could help clinicians assess the risk of PSS in specific post-stroke stages.
Post-stroke seizure (PSS) can have a strong negative impact on functional recovery after stroke. Researchers have identified numerous risk factors of PSS; however, the relationship between infarction location and PSS remains unclear. We recruited patients who presented with an acute cerebral infarction between 2012 and 2017 and suffered from seizures within 1 year after stroke (PSS group). PSS group was subgrouped into early-PSS and late-PSS groups based on the interval between seizure and stroke. We also recruited an equal number of acute cerebral infarction patients without post-stroke seizures during the follow-up period (Non-PSS group). All brain MRIs from the two groups were processed, whereupon normalized infarct maps from the PSS and Non-PSS groups were compared via voxel- and volumetric-based analyses. A total of 132 subjects were enrolled in the study, including PSS (n = 66, consisting of 31 early-PSS and 35 late-PSS) and Non-PSS (n = 66) patients. No significant differences were observed between the two groups in terms of stroke lateralization or severity. Image analysis revealed that the volume of infarction was larger in the PSS group than in the Non-PSS group; however, the difference did not reach the level of significance. Unlike the Non-PSS group, the PSS group presented hot spots over the left central region, left superior parietal lobule, and right frontal operculum. We observed differences between the distribution of hot spots among patients with early-PSS and those with late-PSS. We found that some brain regions were significantly associated with the development of PSS after ischemic stroke, and these regions differed between cases of early and late PSS. It appears that the location of infarction could help clinicians assess the risk of PSS in specific post-stroke stages.
Collapse
Affiliation(s)
- Chien-Chen Chou
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Cheng Shih
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Hsu-Huai Chiu
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Department of Neurology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Hsiang-Yu Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - I-Hui Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Yang Lin
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
40
|
Do PT, Chen LY, Chan L, Hu CJ, Chien LN. Risk Factors for Postischemic Stroke Epilepsy in Young Adults: A Nationwide Population-Based Study in Taiwan. Front Neurol 2022; 13:880661. [PMID: 35669871 PMCID: PMC9163822 DOI: 10.3389/fneur.2022.880661] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe incidence of ischemic stroke has been increasing in the young population over the past 20 years. Poststroke epilepsy (PSE) is a common complication after stroke. However, few population-based studies with sufficient follow-up have investigated factors associated with PSE, especially factors related to comorbidities and unhealthy lifestyles in the modern young population. Accordingly, this study aimed to determine the long-term incidence and these risk factors for PSE young adults.MethodsThis cohort study was conducted using data from the Taiwan National Health Insurance Research Database (NHIRD) from 2002 to 2018. All patients aged between 19 and 44 years and diagnosed with ischemic stroke from 2002 to 2015 were retrospectively enrolled with a follow-up of at least 3 years. Multivariable Cox regression models were performed to identify predictors of PSE, including patients' demographics, baseline conditions, stroke severity, etiologies, comorbidities, and unhealthy behaviors.ResultsAmong 6,512 ischemic stroke patients, 402 cases (6.2%) developed PSE who were with a mean follow-up period of 8.3 years (SD = 4.3 years). During the overall follow-up, stroke severity and manifestations were associated with PSE, including National Institutes of Health Stroke Scale (NIHSS) score ≥10 (aHR, 1.98; 95% CI, 1.50–2.61), seizure at first stroke admission [adjusted hazard ratio (aHR), 57.39; 95% confidence interval (CI), 43.02–76.55], length of hospital stay ≥14 days (aHR, 1.60; 95% CI, 1.26–2.02), recurrent stroke (aHR, 2.32; 95% CI, 1.85–2.90), aphasia (aHR, 1.77; 95% CI, 1.20–2.60), and malignancy (aHR, 2.05; 95% CI, 1.30–3.24). Furthermore, stroke patients with drug abuse were 2.90 times more likely to develop PSE than those without (aHR, 2.90; 95% CI, 1.53–5.50). By contrast, statin use (aHR, 0.62; 95% CI, 0.48–0.80) was associated with a lower risk of PSE. The risk factors at 1-year and 5-year PSE were similar to that of an overall follow-up.ConclusionsStroke severity, aphasia, malignancy, and drug abuse were associated increased risk of PSE and statin use may protect against PSE in young adults. Reducing the severity of stroke, statin use and controlling unhealthy behaviors might be able to decrease the development of PSE. Since PSE is associated with poor outcomes, early identification or intervention of PSE based on the risk factors might reduce the harmful effects of PSE.
Collapse
Affiliation(s)
- Phuong Thao Do
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Pediatrics, Hanoi Medical University, Hanoi, Vietnam
| | - Li-Ying Chen
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Lung Chan
- Department of Neurology and Stroke Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- PhD Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology and Stroke Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- PhD Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Chaur-Jong Hu
| | - Li-Nien Chien
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
- Li-Nien Chien
| |
Collapse
|
41
|
Mao X, Wang X, Jin M, Li Q, Jia J, Li M, Zhou H, Liu Z, Jin W, Zhao Y, Luo Z. Critical involvement of lysyl oxidase in seizure-induced neuronal damage through ERK-Alox5-dependent ferroptosis and its therapeutic implications. Acta Pharm Sin B 2022; 12:3513-3528. [PMID: 36176900 PMCID: PMC9513491 DOI: 10.1016/j.apsb.2022.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 02/08/2023] Open
Abstract
Recent insights collectively suggest the important roles of lysyl oxidase (LysOX) in the pathological processes of several acute and chronic neurological diseases, but the molecular regulatory mechanisms remain elusive. Herein, we explore the regulatory role of LysOX in the seizure-induced ferroptotic cell death of neurons. Mechanistically, LysOX promotes ferroptosis-associated lipid peroxidation in neurons via activating extracellular regulated protein kinase (ERK)-dependent 5-lipoxygenase (Alox5) signaling. In addition, overexpression of LysOX via adeno-associated viral vector (AAV)-based gene transfer enhances ferroptosis sensitivity and aggravates seizure-induced hippocampal damage. Our studies show that pharmacological inhibition of LysOX with β-aminopropionitrile (BAPN) significantly blocks seizure-induced ferroptosis and thereby alleviates neuronal damage, while the BAPN-associated cardiotoxicity and neurotoxicity could further be reduced through encapsulation with bioresponsive amorphous calcium carbonate-based nanocarriers. These findings unveil a previously unrecognized LysOX-ERK-Alox5 pathway for ferroptosis regulation during seizure-induced neuronal damage. Suppressing this pathway may yield therapeutic implications for restoring seizure-induced neuronal injury.
Collapse
|
42
|
Son DK, Cho SM, Ryu HU, Shin BS, Kang HG. Anti-NMDAR encephalitis with bilateral basal ganglia MRI lesions at a distance of time: a case report. BMC Neurol 2022; 22:121. [PMID: 35346099 PMCID: PMC8962229 DOI: 10.1186/s12883-022-02652-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Approximately half (55%) of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is known to show abnormal brain images, including high signal intensity in T2 or fluid attenuated inversion recovery (FLAIR) images. In a minority of anti-NMDAR encephalitis cases, high signal intensity on diffusion-weighted imaging (DWI) has been reported, a finding that is highly suggestive of a stroke. Case presentation We present the case of a 66-year-old man who experienced two separate focal seizure events, which involved first the right and then the left upper extremity in a short period of time. The patient showed focal clonic seizures involving right arm and hand, which sometimes evolved to bilateral tonic-clonic seizures on his first admission. Brain magnetic resonance imaging (MRI) showed high signal intensity on DWI and low signal intensity on the apparent diffusion coefficient (ADC) map of the left caudate nucleus and putamen. The patient was discharged symptom-free with anti-epileptic drugs for 2 weeks. The second admission occurred 4 days after the discharge. He exhibited a new symptom of focal clonic seizures involving left arm and hand while showing a brain lesion on the opposite side which is hyperintense on DWI image and hypointense on ADC map. The patient was eventually diagnosed with anti-NMDAR encephalitis according to the cerebrospinal fluid (CSF) antibody test. Conclusions This is the case of anti-NMDAR encephalitis patient whose DWI/ADC images revealed sequential involvement on the left and right basal ganglia with a short time interval. When stroke-like brain lesions on DWI are found in a patient with a focal seizure, a CSF study could help rule out autoimmune encephalitis. We also suggest that DWI/ADC map images may be useful for the early detection of anti-NMDAR encephalitis.
Collapse
|
43
|
Punia V. Go Ahead! Use that Reperfusion Treatment, don’t Worry About Subsequent Seizures! Epilepsy Curr 2022; 22:105-107. [PMID: 35444510 PMCID: PMC8988720 DOI: 10.1177/15357597221076227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
44
|
Tröscher AR, Gruber J, Wagner JN, Böhm V, Wahl AS, von Oertzen TJ. Inflammation Mediated Epileptogenesis as Possible Mechanism Underlying Ischemic Post-stroke Epilepsy. Front Aging Neurosci 2021; 13:781174. [PMID: 34966269 PMCID: PMC8711648 DOI: 10.3389/fnagi.2021.781174] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/23/2021] [Indexed: 01/19/2023] Open
Abstract
Post-stroke Epilepsy (PSE) is one of the most common forms of acquired epilepsy, especially in the elderly population. As people get increasingly older, the number of stroke patients is expected to rise and concomitantly the number of people with PSE. Although many patients are affected by post-ischemic epileptogenesis, not much is known about the underlying pathomechanisms resulting in the development of chronic seizures. A common hypothesis is that persistent neuroinflammation and glial scar formation cause aberrant neuronal firing. Here, we summarize the clinical features of PSE and describe in detail the inflammatory changes after an ischemic stroke as well as the chronic changes reported in epilepsy. Moreover, we discuss alterations and disturbances in blood-brain-barrier leakage, astrogliosis, and extracellular matrix changes in both, stroke and epilepsy. In the end, we provide an overview of commonalities of inflammatory reactions and cellular processes in the post-ischemic environment and epileptic brain and discuss how these research questions should be addressed in the future.
Collapse
Affiliation(s)
| | - Joachim Gruber
- Neurology I, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.,Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Judith N Wagner
- Neurology I, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.,Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Vincent Böhm
- Neurology I, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.,Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Anna-Sophia Wahl
- Brain Research Institute, University of Zurich, Zurich, Switzerland.,Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Tim J von Oertzen
- Neurology I, Neuromed Campus, Kepler Universitätsklinikum, Linz, Austria.,Medical Faculty, Johannes Kepler University, Linz, Austria
| |
Collapse
|