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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.
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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
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Nandan A, Zhou YM, Demoe L, Waheed A, Jain P, Widjaja E. Incidence and risk factors of post-stroke seizures and epilepsy: systematic review and meta-analysis. J Int Med Res 2023; 51:3000605231213231. [PMID: 38008901 PMCID: PMC10683575 DOI: 10.1177/03000605231213231] [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: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Due to variability in reports, the aim of this meta-analysis was to evaluate the incidence and risk factors of post-stroke early seizures (ES) and post-stroke epilepsy (PSE). METHODS The MEDLINE, EMBASE and Web of Science databases were searched for post-stroke ES/PSE articles published on any date up to November 2020. Post-stroke ES included seizures occurring within 7 days of stroke, and PSE included at least one unprovoked seizure. Using random effects models, the incidence and risk factors of post-stroke ES and PSE were evaluated. The study was retrospectively registered with INPLASY (INPLASY2023100008). RESULTS Of 128 included studies in total, the incidence of post-stroke ES was 0.07 (95% confidence interval [CI] 0.05, 0.10) and PSE was 0.10 (95% CI 0.08, 0.13). The rates were higher in children than adults. Risk factors for post-stroke ES included hemorrhagic stroke (odds ratio [OR] 2.14, 95% CI 1.44, 3.18), severe strokes (OR 2.68, 95% CI 1.73, 4.14), cortical involvement (OR 3.09, 95% CI 2.11, 4.51) and hemorrhagic transformation (OR 2.70, 95% CI 1.58, 4.60). Risk factors for PSE included severe strokes (OR 4.92, 95% CI 3.43, 7.06), cortical involvement (OR 3.20, 95% CI 2.13, 4.81), anterior circulation infarcts (OR 3.28, 95% CI 1.34, 8.03), hemorrhagic transformation (OR 2.81, 95% CI 1.25, 6.30) and post-stroke ES (OR 7.24, 95% CI 3.73, 14.06). CONCLUSION Understanding the risk factors of post-stroke ES/PSE may identify high-risk individuals who might benefit from prophylactic treatment.
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Affiliation(s)
- Aathmika Nandan
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Yi Mei Zhou
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Lindsay Demoe
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Adnan Waheed
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Puneet Jain
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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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.
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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
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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.
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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
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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.
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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
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Inatomi Y, Nakajima M, Yonehara T. Cortical Involvement of a Recent Infarct Contralateral to Early Focal Seizures in Ischemic Stroke. Intern Med 2022; 62:1449-1457. [PMID: 36223921 DOI: 10.2169/internalmedicine.0120-22] [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] [Indexed: 04/07/2023] Open
Abstract
Objective To investigate the frequency and clinical characteristics of ischemic stroke patients with early seizures, especially with cortical involvement contralateral to their focal seizures. Methods We retrospectively studied patients with ischemic stroke admitted to our hospital. We compared the clinical characteristics of patients with and without early seizures (occurring within seven days of the stroke onset). In addition, we divided the patients with early focal seizures into two groups (patients with and without cortical involvement of a recent infarct contralateral to their focal seizure) and compared the clinical characteristics of the groups. Results Of the 5,806 patients with ischemic stroke, 65 (1.2%) were diagnosed with early seizures. A history of ischemic stroke (odds ratio [OR] 1.71), a history of seizures (OR 27.58), and a National Institutes of Health Stroke Scale score on admission (OR 1.07) were significant and independent factors associated with the presence of early seizures. Of these 65 patients, 56 had focal seizures, while the others had generalized or undetermined seizures. Cortical involvement of a recent infarct contralateral to their focal seizures was observed in 24 of these 56 patients (43%). Glucose and hemoglobin A1c levels were significantly higher in patients with cortical involvement of a recent infarct contralateral to their focal seizures than in those with infarcts in other regions. Conclusion These findings suggest that recent infarcts play a role as systemic causes of acute symptomatic seizures as well as an epileptogenic lesion in ischemic stroke patients with early focal seizures.
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Affiliation(s)
| | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
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Kong WY, Marawar R. Acute symptomatic seizures and status epilepticus in older adults: A narrative review focusing on management and outcomes. Front Neurol 2022; 13:954986. [PMID: 36090864 PMCID: PMC9458973 DOI: 10.3389/fneur.2022.954986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
A clear narrative of acute symptomatic seizures (ASyS) in older adults is lacking. Older adults (≥60 years) have the highest incidence of seizures of all age groups and necessitate a tailored approach. ASyS has a bimodal peak in infancy and old age (82.3–123.2/100,000/year after 65 years of age). ASyS can represent half of the new-onset seizures in older adults and can progress to acute symptomatic status epilepticus (ASySE) in 52–72% of the patients. Common etiologies for ASyS in older adults include acute stroke and metabolic disturbances. For ASySE, common etiologies are acute stroke and anoxic brain injury (ABI). Initial testing for ASyS should be consistent with the most common and urgent etiologies. A 20-min electroencephalogram (EEG) is less sensitive in older adults than in younger adults and might not help predict chronic epilepsy. The prolonged postictal phase is an additional challenge for acute management. Studies note that 30% of older adults with ASyS subsequently develop epilepsy. The risk of wrongly equating ASyS as the first seizure of epilepsy is higher in older adults due to the increased long-term challenges with chronic anti-seizure medication (ASM) treatment. Specific challenges to managing ASyS in older adults are related to their chronic comorbidities and polypharmacy. It is unclear if the prognosis of ASyS is dependent on the underlying etiology. Short-term mortality is 1.6 to 3.6 times higher than younger adults. ASySE has high short-term mortality, especially when it is secondary to acute stroke. An acute symptomatic etiology of ASySE had five times increased risk of short-term mortality compared to other types of etiology.
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Mechanical thrombectomy does not increase the risk of acute symptomatic seizures in patients with an ischaemic stroke: a propensity score matching study. J Neurol 2022; 269:3328-3336. [PMID: 35048192 PMCID: PMC9119889 DOI: 10.1007/s00415-022-10968-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/12/2022]
Abstract
Background Mechanical thrombectomy and systemic thrombolysis are important therapies for stroke patients. However, there is disagreement about the accompanying risk of acute symptomatic seizures. Methods A retrospective analysis of patients with an acute ischaemic stroke caused by large vessel occlusion was performed. The patients were divided into four groups based on whether they received either mechanical thrombectomy (MT) or systemic thrombolysis (ST; group 1: MT+/ST−; group 2: MT+/ST+; group 3: MT−/ST+; group 4: MT−/ST−). Propensity score matching was conducted for each group combination (1:3, 1:4, 2:3, 2:4, 1:2, 3:4) using the covariates “NIHSS at admission”, “mRS prior to event” and “age”. The primary endpoint was defined as the occurrence of acute symptomatic seizures. Results A total of 987 patients met the inclusion criteria, of whom 208, 264, 169 and 346 belonged to groups 1, 2, 3 and 4, respectively. Propensity score matched groups consisted of 160:160, 143:143, 156:156, 144:144, 204:204 and 165:165 patients for the comparisons 1:3, 1:4, 2:3, 2:4, 1:2 and 3:4, respectively. Based on chi-squared tests, there was no significant difference in the frequency of acute symptomatic seizures between the groups. Subgroups varied in their frequency of acute symptomatic seizures, ranging from 2.8 to 3.8%, 2.8–4.4%, 3.6–3.8% and 4.9–6.3% in groups 1, 2, 3 and 4, respectively. Conclusion There was no association between MT or ST and an increased risk of acute symptomatic seizures in patients with an acute ischaemic stroke caused by large vessel occlusion who were treated at a primary stroke centre. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-10968-5.
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Mushannen T, Aleyadeh R, Siddiqui M, Saqqur M, Akhtar N, Mesraoua B, Al Jerdi S, Melikyan G, Shaheen Y, Qadourah H, Chagoury O, Mahfoud ZR, Haddad N. Effect of Reperfusion Therapies on Incidence of Early Post-Stroke Seizures. Front Neurol 2021; 12:758181. [PMID: 34880824 PMCID: PMC8645550 DOI: 10.3389/fneur.2021.758181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to determine the effect of reperfusion therapies on the occurrence of early post-stroke seizures (PSS) in patients with acute ischemic stroke (AIS). Background: Reperfusion therapies are paramount to the treatment of stroke in the acute phase. However, their effect on the incidence of early seizures after an AIS remains unclear. Design and Methods: The stroke database at Hamad Medical Corporation was used to identify all patients who received reperfusion therapies for AIS from 2016 to 2019. They were matched with patients of similar diagnosis, gender, age, and stroke severity as measured by National Institutes of Health Stroke Scale (NIHSS) who did not receive such treatment. The rates of early PSS were calculated for each group. Results: The results showed that 508 patients received reperfusion therapies (342 had IV thrombolysis only, 70 had thrombectomies only, and 96 had received both), compared with 501 matched patients receiving standard stroke unit care. Patients who received reperfusion therapies were similar to their matched controls for mean admission NIHSS score (9.87 vs. 9.79; p = 0.831), mean age (53.3 vs. 53.2 years; p = 0.849), and gender distribution (85 vs. 86% men; p = 0.655). The group receiving reperfusion therapies was found to have increased stroke cortical involvement (62 vs. 49.3%, p < 0.001) and hemorrhagic transformation rates (33.5 vs. 18.6%, p < 0.001) compared with the control group. The rate of early PSS was significantly lower in patients who received reperfusion therapies compared with those who did not (3.1 vs. 5.8%, respectively; p = 0.042). When we excluded seizures occurring at stroke onset prior to any potential treatment implementation, the difference in early PSS rates between the two groups was no longer significant (2.6 vs. 3.9%, respectively; p = 0.251). There was no significant difference in early PSS rate based on the type of reperfusion therapy either (3.2% with thrombolysis, 2.9% with thrombectomy, and 3.1% for the combined treatment, p = 0.309). Conclusions: Treatment of AIS with either thrombectomy, thrombolysis, or both does not increase the risk of early PSS.
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Affiliation(s)
- Tasnim Mushannen
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Rozaleen Aleyadeh
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Maria Siddiqui
- Department of Neurology Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Maher Saqqur
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar.,Department of Neurology Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Naveed Akhtar
- Department of Neurology Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Boulenouar Mesraoua
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar.,Department of Neurology Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Salman Al Jerdi
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar.,Department of Neurology Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Gayane Melikyan
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar.,Department of Neurology Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Yanal Shaheen
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Haneen Qadourah
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Odette Chagoury
- Department of Medicine, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar.,Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad R Mahfoud
- Department of Population Health Sciences, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Naim Haddad
- Department of Neurology, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar.,Department of Neurology Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar
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Zöllner JP, Schmitt FC, Rosenow F, Kohlhase K, Seiler A, Strzelczyk A, Stefan H. Seizures and epilepsy in patients with ischaemic stroke. Neurol Res Pract 2021; 3:63. [PMID: 34865660 PMCID: PMC8647498 DOI: 10.1186/s42466-021-00161-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the increased efficacy of stroke treatments, diagnosis and specific treatment needs of patients with post-stroke seizures (PSS) and post-stroke epilepsy have become increasingly important. PSS can complicate the diagnosis of a stroke and the treatment of stroke patients, and can worsen post-stroke morbidity. This narrative review considers current treatment guidelines, the specifics of antiseizure treatment in stroke patients as well as the state-of-the-art in clinical and imaging research of post-stroke epilepsy. Treatment of PSS needs to consider indications for antiseizure medication treatment as well as individual clinical and social factors. Furthermore, potential interactions between stroke and antiseizure treatments must be carefully considered. The relationship between acute recanalizing stroke therapy (intravenous thrombolysis and mechanical thrombectomy) and the emergence of PSS is currently the subject of an intensive discussion. In the subacute and chronic post-stroke phases, important specific interactions between necessary antiseizure and stroke treatments (anticoagulation, cardiac medication) need to be considered. Among all forms of prevention, primary prevention is currently the most intensively researched. This includes specifically the repurposing of drugs that were not originally developed for antiseizure properties, such as statins. PSS are presently the subject of extensive basic clinical research. Of specific interest are the role of post-stroke excitotoxicity and blood-brain barrier disruption for the emergence of PSS in the acute symptomatic as well as late (> 1 week after the stroke) periods. Current magnetic resonance imaging research focussing on glutamate excitotoxicity as well as diffusion-based estimation of blood-brain barrier integrity aim to elucidate the pathophysiology of seizures after stroke and the principles of epileptogenesis in structural epilepsy in general. These approaches may also reveal new imaging-based biomarkers for prediction of PSS and post-stroke epilepsy. CONCLUSION PSS require the performance of individual risk assessments, accounting for the potential effectiveness and side effects of antiseizure therapy. The use of intravenous thrombolysis and mechanical thrombectomy is not associated with an increased risk of PSS. Advances in stroke imaging may reveal biomarkers for PSS.
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Affiliation(s)
- Johann Philipp Zöllner
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | | | - Felix Rosenow
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Konstantin Kohlhase
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Alexander Seiler
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Hermann Stefan
- Department of Neurology - Biomagnetism, University Hospital Erlangen, Erlangen, Germany
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11
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Agarwal A, Sharma J, Padma Srivastava MV, Bhatia R, Singh MB, Gupta A, Pandit AK, Singh R, Rajan R, Dwivedi S, Upadhyay A, Garg A, Vishnu VY. Early Post-Stroke Seizures in Acute Ischemic Stroke: A Prospective Cohort Study. Ann Indian Acad Neurol 2021; 24:580-585. [PMID: 34728954 PMCID: PMC8513968 DOI: 10.4103/aian.aian_1283_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/31/2021] [Accepted: 03/01/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Stroke is the most common cause of epilepsy in the adult population. Post-stroke seizures (PSSs) are classified into early-onset seizures (ES) and late-onset (LS). ES can significantly affect the clinical outcome and occurrence of LS. Methods We analyzed data from a prospective cohort of acute ischemic stroke patients between June 2018 and May 2020 in a neurology unit at a tertiary hospital. We screened all acute stroke patients and included consecutive patients older than 18 years of age, presenting with acute, first-ever neuroimaging-confirmed ischemic stroke. We excluded patients with a previous stroke, transient ischemic attacks, hemorrhagic stroke, cerebral venous thrombosis, prior history of seizures, or any other epileptogenic comorbidity. ES were classified as spontaneous seizures occurring within 1 week of the stroke. The main outcome assessed was the occurrence of ES. The secondary outcome was to determine predictors of ES and create an ES prediction score. Results We screened 432 patients; of them, 291 were enrolled. ES occurred in 37 patients (12.7%). Cortical location (OR: 4.2), large artery disease subtype (OR: 2.9), mRS at presentation (OR: 1.4), use of anticoagulants (OR: 2.6), and hypertension (OR: 0.3) were significantly associated with the occurrence of ES. Patients with ES had a statistically significant worse clinical outcome at 3 months follow-up (P = 0.0072). Conclusion We could formulate an ES prediction tool using the following components: (a) cortical location, (b) large vessel stroke, (c) mRS at admission, (d) anticoagulant use, and (e) presence of hypertension. This tool might help in treating patients at high risk for ES with prophylactic ASD, thereby preventing seizures and their complications.
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Affiliation(s)
- Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Sharma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh K Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sadanand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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12
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Zhao L, Li J, Kälviäinen R, Jolkkonen J, Zhao C. Impact of drug treatment and drug interactions in post-stroke epilepsy. Pharmacol Ther 2021; 233:108030. [PMID: 34742778 DOI: 10.1016/j.pharmthera.2021.108030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/21/2022]
Abstract
Stroke is a huge burden on our society and this is expected to grow in the future due to the aging population and the associated co-morbidities. The improvement of acute stroke care has increased the survival rate of stroke patients, and many patients are left with permanent disability, which makes stroke the main cause of adult disability. Unfortunately, many patients face other severe complications such as post-stroke seizures and epilepsy. Acute seizures (ASS) occur within 1 week after the stroke while later occurring unprovoked seizures are diagnosed as post-stroke epilepsy (PSE). Both are associated with a poor prognosis of a functional recovery. The underlying neurobiological mechanisms are complex and poorly understood. There are no universal guidelines on the management of PSE. There is increasing evidence for several risk factors for ASS/PSE, however, the impacts of recanalization, drugs used for secondary prevention of stroke, treatment of stroke co-morbidities and antiseizure medication are currently poorly understood. This review focuses on the common medications that stroke patients are prescribed and potential drug interactions possibly complicating the management of ASS/PSE.
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Affiliation(s)
- Lanqing Zhao
- Department of Sleep Medicine Center, The Shengjing Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Jinwei Li
- Department of Stroke Center, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China
| | - Reetta Kälviäinen
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Full Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka Jolkkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Chuansheng Zhao
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, PR China.
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13
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Alemany M, Nuñez A, Falip M, Lara B, Paipa A, Quesada H, Mora P, De Miquel MA, Barranco R, Pedro J, Cardona P. Acute symptomatic seizures and epilepsy after mechanical thrombectomy. A prospective long-term follow-up study. Seizure 2021; 89:5-9. [PMID: 33933947 DOI: 10.1016/j.seizure.2021.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION New treatments for acute ischaemic stroke, such as mechanical thrombectomy, can achieve reperfusion of large ischaemic tissue. Some studies have suggested that reperfusion therapies can increase the risk of suffering acute symptomatic seizure (ASS) and poststroke epilepsy (PSE). The aim of the study was to determine the incidence of ASS and PSE in patients undergoing thrombectomy, and related factors. PATIENTS AND METHODS This was a retrospective single-centre study including patients with ischaemic stroke and NIHSS> 8 treated with thrombectomy with a follow-up ≥5 years. We evaluated several epidemiological, radiological, clinical and electroencephalographic variables. RESULTS Of the 344 included patients, 21 (6.1%) presented ASS, 53 (15.40%) died in the acute phase, and 13 (4.46%) died during the first year. The degree of reperfusion (p 0.029), advanced age (p 0.035), and haemorrhagic transformation (p 0.038) increased the risk of suffering ASS, with degree of reperfusion being an independent factor, OR 2.02 (1.21-4.64). The incidence of PSE was 4.12% in the first year, 3.72% in the second, and 1.61% in the fifth. The accumulated incidence at 5 years was 8.93%. Related risk factor for suffering PSE was ASS (p < 0.001), yielding an OR value of 2.00 (1.28-3.145). CONCLUSIONS Thrombectomy doesn´t increase the risk of ASS. A higher percentage of reperfusion, advanced age, and haemorrhagic transformation are associated with an increased risk of ASS. ASS is a risk factor for suffering PSE. In terms of mortality, having suffered ASS and/or PSE does not increase acute or long-term mortality.
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Affiliation(s)
- M Alemany
- Neuro-Oncology Unit, Neurology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Nuñez
- Stroke Unit, Neurology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Falip
- Epilepsy Unit, Neurology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - B Lara
- Stroke Unit, Neurology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Paipa
- Stroke Unit, Neurology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - H Quesada
- Stroke Unit, Neurology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Mora
- Neuroradiology Department, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M A De Miquel
- Neuroradiology Department, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Barranco
- Neuroradiology Department, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Pedro
- Neurophysiology Unit, Neurology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Cardona
- Stroke Unit, Neurology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain..
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14
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Anfray A, Brodin C, Drieu A, Potzeha F, Dalarun B, Agin V, Vivien D, Orset C. Single- and two- chain tissue type plasminogen activator treatments differentially influence cerebral recovery after stroke. Exp Neurol 2021; 338:113606. [PMID: 33453214 DOI: 10.1016/j.expneurol.2021.113606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Tissue type Plasminogen Activator (tPA), named alteplase (Actilyse®) under its commercial form, is currently the only pharmacological treatment approved during the acute phase of ischemic stroke, used either alone or combined with thrombectomy. Interestingly, the commercial recombinant tPA (rtPA) contains two physiological forms of rtPA: the single chain rtPA (sc-rtPA) and the two-chains rtPA (tc-rtPA), with differential properties demonstrated in vitro. Using a relevant mouse model of thromboembolic stroke, we have investigated the overall effects of these two forms of rtPA when infused early after stroke onset (i.e. 20 min) on recanalization, lesion volumes, alterations of the integrity of the blood brain barrier and functional recovery. Our data reveal that there is no difference in the capacity of sc-rtPA and tc-rtPA to promote fibrinolysis and reperfusion of the tissue. However, compared to sc-rtPA, tc-rtPA is less efficient to reduce lesion volumes and to improve functional recovery, and is associated with an increased opening of the blood brain barrier. These data indicate better understanding of differential effects of these tPA forms might be important to ultimately improve stroke treatment.
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Affiliation(s)
- Antoine Anfray
- Normandie Univ, UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France
| | - Camille Brodin
- Normandie Univ, UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France
| | - Antoine Drieu
- Normandie Univ, UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France
| | - Fanny Potzeha
- Normandie Univ, UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France
| | - Basile Dalarun
- Normandie Univ, UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France
| | - Véronique Agin
- Normandie Univ, UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France
| | - Denis Vivien
- Normandie Univ, UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France; CHU Caen, Department of Clinical Research, Caen University Hospital, Avenue de la Côte de Nacre, Caen, France.
| | - Cyrille Orset
- Normandie Univ, UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Caen, France
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15
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Zöllner JP, Misselwitz B, Mauroschat T, Roth C, Steinmetz H, Rosenow F, Strzelczyk A. Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke. Sci Rep 2020; 10:21083. [PMID: 33273538 PMCID: PMC7713428 DOI: 10.1038/s41598-020-78012-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022] Open
Abstract
Recent data have suggested that performing recanalizing therapies in ischemic stroke might lead to an increased risk of acute symptomatic seizures. This applies to both intravenous thrombolysis and mechanical thrombectomy. We therefore determined the frequency of acute symptomatic seizures attributable to these two recanalization therapies using a large, population-based stroke registry in Central Europe. We performed two matched 1:1 case–control analyses. In both analyses, patients were matched for age, stroke severity on admission and pre-stroke functional status. The first analysis compared patients treated with intravenous thrombolysis to a non-recanalization control group. To isolate the effect of mechanical thrombectomy, we compared patients with both mechanical thrombectomy and intravenous thrombolysis to those with only intravenous thrombolysis treatment in a second analysis. From 135,117 patients in the database, 13,356 patients treated with only intravenous thrombolysis, and 1013 patients treated with both intravenous thrombolysis and mechanical thrombectomy were each matched to an equivalent number of controls. Patients with intravenous thrombolysis did not suffer from clinically apparent acute symptomatic seizures significantly more often than non-recanalized patients (treatment = 199; 1.5% vs. control = 237; 1.8%, p = 0.07). Mechanical thrombectomy in addition to intravenous thrombolysis also was not associated with an increased risk of acute symptomatic seizures, as the same number of patients suffered from seizures in the treatment and control group (both n = 17; 1.7%, p = 1). In a large population-based stroke registry, the frequency of clinically apparent acute symptomatic seizures was not increased in patients who received either intravenous thrombolysis alone or in conjunction with mechanical thrombectomy.
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Affiliation(s)
- Johann Philipp Zöllner
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. .,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Björn Misselwitz
- Quality Assurance Office Hessen (GQH, Geschäftsstelle Qualitätssicherung Hessen), Eschborn, Germany
| | - Thomas Mauroschat
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Christian Roth
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany.,Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany
| | - Helmuth Steinmetz
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.,Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany
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16
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Ba K, Casolla B, Caparros F, Bricout N, Della Schiava L, Pasi M, Dequatre-Ponchelle N, Bodenant M, Bordet R, Cordonnier C, Hénon H, Leys D. Early epileptic seizures in ischaemic stroke treated by mechanical thrombectomy: influence of rt-PA. J Neurol 2020; 268:305-311. [PMID: 32797298 DOI: 10.1007/s00415-020-10155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/05/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The epileptogenicity of recombinant tissue-plasminogen activator (rt-PA) has been suggested, but seizures were not evaluated in randomised controlled trials. OBJECTIVE To evaluate whether rt-PA was associated with early seizures in a cohort of consecutive patients with cerebral ischaemia. METHOD We included consecutive adults with ischaemic stroke due to large-vessel occlusion from the North-of-France stroke network selected for a mechanical thrombectomy (MT). Patients without contraindication received i.v. rt-PA. We evaluated stroke severity with the National Institutes of Health Stroke Scale (NIHSS), and functional status with the modified Rankin scale (mRS), and recorded epileptic seizures occurring between the end of imaging and day 7. We performed statistics using propensity analyses. RESULTS We included 1638 patients (783 men, 47.8%; median age 71 years; median NIHSS score 16; 1007 treated by rt-PA, 61.5%), in whom 60 (3.7%) developed early epileptic seizures. After adjustment on propensity scores, early seizures were associated with infections [adjusted odds ratio (adjOR) 2.86; 95% confidence interval (CI) 1.37-5.95] and delay between stroke recognition and end of MT (adjOR 1.04 for 10 min more; 95% CI 1.01-1.08), but not with rt-PA (adjOR 1.35; 95% CI 0.55-3.33). The propensity-matched analysis of 343 pairs of patients found no difference in the occurrence of early seizures between those with and without rt-PA (p = 0.386). CONCLUSION We found no significant association between rt-PA and early epileptic seizures. If rt-PA has the potential for epileptogenicity, the magnitude of the effect should be modest compared to its favourable effect on functional outcome.
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Affiliation(s)
- Khadija Ba
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Barbara Casolla
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - François Caparros
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Nicolas Bricout
- Department of Neuroradiology, Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Lucie Della Schiava
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Marco Pasi
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Nelly Dequatre-Ponchelle
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Marie Bodenant
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Régis Bordet
- Department of Pharmacology, Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Charlotte Cordonnier
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Hilde Hénon
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France
| | - Didier Leys
- Department of Neurology (Stroke Unit), Lille Neuroscience and Cognition, Degenerative and Vascular Cognitive Disorders, University of Lille, INSERM (U-1172), CHU Lille, 59000, Lille, France.
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17
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Lekoubou A, Fox J, Ssentongo P. Incidence and Association of Reperfusion Therapies With Poststroke Seizures: A Systematic Review and Meta-Analysis. Stroke 2020; 51:2715-2723. [PMID: 32772682 DOI: 10.1161/strokeaha.119.028899] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE We performed a systematic review and meta-analysis to assess the incidence and risk of seizures following acute stroke reperfusion therapy (intravenous thrombolysis [IVT] with r-tPA [recombinant tissue-type plasminogen activator], mechanical thrombectomy or both). METHODS We searched major databases (MEDLINE, SCOPUS, and Cochrane Library) for articles published between 1995 and October 28, 2019. The primary outcome was the overall and treatment specific pooled incidence of poststroke seizures (PSS) following acute reperfusion therapy. We also computed the pooled incidence of early poststroke seizures and late poststroke seizures separately for all studies. We derived the risk of PSS associated with IVT in the pooled cohort of patients who received only IVT. The small number of studies (<3) that reported on the risk of PSS associated with mechanical thrombectomy alone or in combination with IVT did not allow us to compute an estimate of the risk of seizures associated with this therapy. RESULTS We identified 13 753 patients with stroke, of which 592 had seizures. The pooled incidence of PSS was 5.9 % (95% CI, 4.2%-8.2%). PSS incidence rates among patients with stroke treated with IVT, mechanical thrombectomy, and both were respectively 6.1% (95% CI, 3.6%-10.2%), 5.9% (95% CI, 4.1%-8.4%), and 5.8 % (95% CI, 3.0%-10.9%). The incidence of late PSS was 6.7% (95% CI, 4.01%-11.02%) and that of early PSS was 3.14% (95% CI, 2.05%-4.76%). The pooled odds ratio for the association between IVT and PSS was 1.24 (95% CI, 0.75-2.05). CONCLUSIONS The findings of this meta-analysis suggest that about one in 15 ischemic stroke patients treated with IVT, mechanical thrombectomy, or both develop seizures independently of the specific reperfusion treatment that they received.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology (A.L.), Penn State University, Hershey, PA.,Division of Epidemiology, Department of Public Health Sciences (A.L., P.S.), Penn State University, Hershey, PA
| | - Jonah Fox
- Department of Neurology, Medical University of South Carolina, Charleston (J.F.)
| | - Paddy Ssentongo
- Division of Epidemiology, Department of Public Health Sciences (A.L., P.S.), Penn State University, Hershey, PA
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18
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Brigo F, Schneider M, Wagenpfeil G, Unger MM, Holzhoffer C, Walter S, Faßbender K, Lochner P. Early poststroke seizures following thrombolysis and/or thrombectomy for acute stroke: Clinical and stroke characteristics. Epilepsy Behav 2020; 104:106353. [PMID: 31231037 DOI: 10.1016/j.yebeh.2019.05.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
In this retrospective study, we explored the clinical and stroke characteristics of patients treated with thrombolysis and/or mechanical thrombectomy for an acute stroke and experiencing early poststroke seizures within 7 days of the cerebrovascular accident. Patients with prior epilepsy, primary intracerebral hemorrhage or transient ischemic attacks, or taking antiepileptic drugs were excluded. We retrospectively identified 32 patients admitted between 2010 and 2016 (mean age 75 years; range: 49-90; 14 females and 18 males). A cortical stroke was found in more than 70% of patients. Most epileptic seizures were focal aware (46.7%) or generalized convulsive (43.3%). The median time between stroke onset and seizure occurrence was 2 days; in 75.9% of the cases, seizures occurred within the first 3 days. This retrospective case series is the largest published so far providing details on clinical features of patients with early poststroke seizures following different reperfusion therapies, not only restricted to intravenous (i.v.) thrombolysis. Early poststroke seizures following reperfusion therapies are associated with cortical stroke involvement, are usually focal without impairment of awareness or generalized convulsive, and occur mostly within the first 3 days. Further studies are needed to clarify whether the low prevalence of focal impaired awareness seizures (and nonconvulsive seizures/status) is real or reflects the failure to recognize and correctly diagnose this seizure type in the acute poststroke period (risk of underascertainment due to the lack of systematic video-electroencephalogram (EEG) recording in patients with stroke and difficulties in recognizing these seizures). This article is part of the Special Issue "Seizures & Stroke".
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Affiliation(s)
- Francesco Brigo
- Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.
| | | | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg, Germany
| | | | - Claudia Holzhoffer
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Silke Walter
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Klaus Faßbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
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Reperfusion therapies and poststroke seizures. Epilepsy Behav 2020; 104:106524. [PMID: 31727547 DOI: 10.1016/j.yebeh.2019.106524] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023]
Abstract
Seizures are not only a frequent complication of stroke but have been associated with an unfavorable functional and vital outcome of patients who have had stroke. Facing a new paradigm of acute standard stroke care, acute symptomatic seizures in this clinical setting deserve to be rethought. Reperfusion therapies, the gold standard treatment for acute ischemic stroke, improve long-term survival and outcome of patients who have had stroke and have been associated both with clinical seizures and the occurrence of epileptiform activity in the electroencephalogram (EEG). This narrative review describes the different physiopathological mechanisms underlying the possible association between reperfusion therapies and seizures, both acute symptomatic seizures and unprovoked seizures, and the current evidence regarding the risk of poststroke seizures in treated patients. It also identifies the gaps in our knowledge to foster future studies in this field. By different mechanisms, reperfusions therapies may have opposing effects on the risk of poststroke seizures. There is a need for a better definition of the specific physiopathology of seizures in clinical practice, as many factors can be recognized. Additionally, most of the current clinical evidence refers to acute symptomatic seizures and not to unprovoked seizures or poststroke epilepsy, and our analysis does not support the existence of a strong association between thrombolysis and poststroke seizures. So far, the impact of reperfusion therapies on the frequency of poststroke seizures is unclear. To study this effect, many clinical challenges must be overcome, including a better and clear operational definition of seizures and stroke characteristics, the standard of stroke and epilepsy care and EEG monitoring, and the degree of reperfusion success. Prospective, high quality, larger, and longer follow-up multicentric studies are urgently needed. Additionally, stroke registries can also prove useful in better elucidate whether there is an association between reperfusion therapies and seizures. This article is part of the Special Issue "Seizures & Stroke".
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Belcastro V, Brigo F, Ferlazzo E, Gasparini S, Mastroianni G, Cianci V, Lattanzi S, Silvestrini M, Versino M, Banfi P, Carimati F, Grampa G, Lochner P, Gigli GL, Bax F, Merlino G, Valente M, Vidale S, Aguglia U. Incidence of early poststroke seizures during reperfusion therapies in patients with acute ischemic stroke: An observational prospective study: (TESI study: "Trombolisi/Trombectomia e crisi Epilettiche precoci nello Stroke Ischemico"). Epilepsy Behav 2020; 104:106476. [PMID: 31431399 DOI: 10.1016/j.yebeh.2019.106476] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The aim of this study was to prospectively investigate the occurrence of early poststroke seizures (within 7 days of stroke) in patients undergoing reperfusion therapies (intravenous rtPA [recombinant tissue plasminogen activator] and/or endovascular thrombectomy) in comparison to those not undergoing these procedures. METHODS Patients aged ≥18 years with acute ischemic stroke admitted in five Italian centers were prospectively recruited. Clinical data, details on stroke type and etiology, stroke treatment, and radiological data were collected. The frequency of early poststroke seizures was assessed, and predictive factors for their occurrence were evaluated. RESULTS Five hundred and sixteen patients (262 in the reperfusion therapies group) were included. Stroke severity on admission and at discharge was higher among patients undergoing reperfusion therapies. Ten patients (3.8%) undergoing reperfusion therapies and 6 (2.3%) of those not receiving these treatments experienced early poststroke seizures (p = 0.45). There were no differences in any of the baseline characteristics between patients experiencing and those not experiencing early seizures. CONCLUSION The incidence of early poststroke seizures was overall rare, and no significant differences emerged between patients receiving and those not receiving reperfusion therapies. This article is part of the Special Issue "Seizures and Stroke".
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Affiliation(s)
| | - Francesco Brigo
- Hospital Franz Tappeiner, Department of Neurology, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre and Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli" of Reggio Calabria, Italy.
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre and Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli" of Reggio Calabria, Italy
| | - Giovanni Mastroianni
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre and Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli" of Reggio Calabria, Italy
| | - Vittoria Cianci
- Neurology and Stroke Unit, Great Metropolitan Hospital, Reggio Cal., Italy
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Maurizio Versino
- Neurology and Stroke Units, Circolo Hospital and Macchi Foundation, Varese, Italy; DMC Department, University of Insubria, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Units, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Federico Carimati
- Neurology and Stroke Units, Circolo Hospital and Macchi Foundation, Varese, Italy
| | | | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | | | - Francesco Bax
- Clinical Neurology Unit, University of Udine, Udine, Italy
| | | | | | | | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre and Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli" of Reggio Calabria, Italy
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Intravenous thrombolysis with tPA and cortical involvement increase the risk of early poststroke seizures: Results of a case-control study. Epilepsy Behav 2020; 104:106312. [PMID: 31182396 DOI: 10.1016/j.yebeh.2019.04.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/22/2022]
Abstract
The aim of this study was to identify the risk factors for early poststroke seizures (PSS) in patients with acute ischemic stroke. We undertook a case-control study at a single stroke center. Patients with seizure occurring during the first 7 days following ischemic stroke admitted between 2010 and 2016 were retrospectively identified and matched with controls (patients with stroke without early PSS) for age and sex. We included 79 cases and 158 controls. Blood sugar levels on admission, stroke localization, National Institutes of Health Stroke Scale (NIHSS) and Rankin score, and intravenous (i.v.) thrombolysis with recombinant tissue plasminogen activator (rtPA) were statistically associated with early PSS in univariate analysis. Multiple logistic regression after forward and backward variable selection identified cortical stroke localization (odds ratio (OR): 2.49; 95% confidence intervals (CI): 1.35 to 4.59; p = 0.003) and i.v. thrombolysis (OR: 2.26; 95% CI: 1.16 to 4.43; p = 0.008) as variables independently associated with early PSS. Cortical involvement and i.v. thrombolysis are independent risk factors associated with the occurrence of early PSS. This association is not explained by age or sex, concomitant drugs, diabetes or alcoholism, sodium and cholesterol levels, blood pressure on admission, stroke etiology or severity, and hemorrhage following i.v. thrombolysis. Further studies are required to fully elucidate the association between different reperfusion therapies and early PSS. This article is part of the Special Issue "Seizures & Stroke".
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Gasparini S, Ascoli M, Brigo F, Cianci V, Branca D, Arcudi L, Aguglia U, Belcastro V, Ferlazzo E. Younger age at stroke onset but not thrombolytic treatment predicts poststroke epilepsy: An updated meta-analysis. Epilepsy Behav 2020; 104:106540. [PMID: 31677999 DOI: 10.1016/j.yebeh.2019.106540] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022]
Abstract
AIMS Stroke is the most commonly identified cause of late-onset epilepsy. Risk factors for poststroke epilepsy (PSE) are partially elucidated, and many studies have been performed in recent years. We aimed to update our previous systematic review and meta-analysis on risk factors for PSE. METHODS PubMed, Google Scholar, and Scopus databases were searched. Articles published in English (1987-2019) were included. Odds ratios (OR) and mean values were calculated for examined variables. RESULTS Thirty studies with different designs were included, enrolling 26,045 patients who experienced stroke, of whom 1800 had PSE, corresponding to a prevalence of 7%. Cortical lesions (OR: 3.58, 95% confidence interval (CI): 2.35-5.46, p < 0.001), hemorrhagic component (OR: 2.47, 95% CI: 1.68-3.64, p < 0.001), early seizures (ES) (OR: 4.88, 95% CI: 3.08-7.72, p < 0.001), and younger age at stroke onset (difference in means: 2.97 years, 95% CI: 0.78 to 5.16, p = 0.008) favor PSE. Sex and acute treatment with recombinant tissue plasminogen activator (rtPA) do not predict the occurrence of PSE. CONCLUSION Despite limitations due to the uneven quality and design of the studies, the present meta-analysis confirms that cortical involvement, hemorrhagic component, and ES are associated with a higher risk of PSE. In this update, younger age at stroke onset but not thrombolytic treatment seems to increase the risk for PSE. This article is part of the Special Issue "Seizures & Stroke".
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Affiliation(s)
- Sara Gasparini
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy; Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Michele Ascoli
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy; Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Hospital Franz Tappeiner, Department of Neurology, Merano, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Damiano Branca
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Luciano Arcudi
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy; Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
| | | | - Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy; Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
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Abstract
INTRODUCTION Stroke is a significant underlying cause of epilepsy. Seizures due to ischemic stroke (IS) are generally categorized into early seizures (ESs) and late seizures (LSs). Seizures in thrombolysis situations may raise the possibility of other etiology than IS. AIM We overtook a systematic review focusing on the pathogenesis, prevalence, risk factors, detection, management, and clinical outcome of ESs in IS and in stroke/thrombolysis situations. We also collected articles focusing on the association of recombinant tissue-type plasminogen activator (rt-PA) treatment and epileptic seizures. RESULTS We have identified 37 studies with 36,775 participants. ES rate was 3.8% overall in patients with IS with geographical differences. Cortical involvement, severe stroke, hemorrhagic transformation, age (<65 years), large lesion, and atrial fibrillation were the most important risk factors. Sixty-one percent of ESs were partial and 39% were general. Status epilepticus (SE) occurred in 16.3%. 73.6% had an onset within 24 h and 40% may present at the onset of stroke syndrome. Based on EEG findings seizure-like activity could be detected only in approximately 18% of ES patients. MRI diffusion-weighted imaging and multimodal brain imaging may help in the differentiation of ischemia vs. seizure. There are no specific recommendations with regard to the treatment of ES. CONCLUSION ESs are rare complications of acute stroke with substantial burden. A significant proportion can be presented at the onset of stroke requiring an extensive diagnostic workup.
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Brondani R, de Almeida AG, Cherubini PA, Secchi TL, de Oliveira MA, Martins SCO, Bianchin MM. Risk Factors for Epilepsy After Thrombolysis for Ischemic Stroke: A Cohort Study. Front Neurol 2020; 10:1256. [PMID: 32038448 PMCID: PMC6989601 DOI: 10.3389/fneur.2019.01256] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
The effects of thrombolysis in seizure and epilepsy after acute ischemic stroke have been poorly explored. In this study, we examine risk factors and consequences of intravenous rt-PA for treatment of acute ischemic stroke. In a retrospective cohort study we evaluate risk factors for seizure and epilepsy after stroke thrombolysis, as well as the impact of seizures and epilepsy in outcome of stroke patients. In our cohort, mean age of patients was 67.2 years old (SD = 13.1) and 79 of them (51.6%) were male and. Initial NIHSS mean score were 10.95 (SD = 6.25). Three months NIHSS mean score was 2.09 (SD = 3.55). Eighty seven (56.9%) patients were mRS of 0–1 after thrombolysis. Hemorrhagic transformation was observed in 22 (14.4%) patients. Twenty-one (13.7%) patients had seizures and 15 (9.8%) patients developed epilepsy after thrombolysis. Seizures were independently associated with hemorrhagic transformation (OR = 3.26; 95% CI = 1.08–9.78; p = 0.035) and with mRS ≥ 2 at 3 months after stroke (OR = 3.51; 95% CI = 1.20–10.32; p = 0.022). Hemorrhagic transformation (OR = 3.55; 95% CI = 1.11–11.34; p = 0.033) and mRS ≥ 2 at 3 months (OR = 5.82; 95% CI = 1.45–23.42; p = 0.013) were variables independently associated with post-stroke epilepsy. In our study, independent risks factors for poor outcome in stroke thrombolysis were age (OR = 1.03; 95% CI = 1.01–1.06; p = 0.011), higher NIHSS (OR = 1.08; 95% CI = 1.03–1.14; p = 0.001), hemorrhagic transformation (OR = 2.33; 95% CI = 1.11–4.76; p = 0.024), seizures (OR = 3.07; 95% CI = 1.22–7.75; p = 0.018) and large cortical area (ASPECTS ≤ 7) (OR = 2.04; 95% CI = 1.04–3.84; p = 0.036). Concluding, in this retrospective cohort study, the neurological impairment after thrombolysis (but not before) and hemorrhagic transformation remained independent risk factors for seizures or post-stroke epilepsy after thrombolysis. Moreover, we observed that seizures emerged as an independent risk factor for poor outcome after thrombolysis therapy in stroke patients (OR = 3.07; 95% CI = 1.22–7.75; p = 0.018).
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Affiliation(s)
- Rosane Brondani
- Graduate Program in Medicine: Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Basic Research and Advanced Investigations in Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Andrea Garcia de Almeida
- Graduate Program in Medicine: Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Basic Research and Advanced Investigations in Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro Abrahim Cherubini
- Basic Research and Advanced Investigations in Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,CETER-Center for Epilepsy Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Thaís Leite Secchi
- Graduate Program in Medicine: Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Basic Research and Advanced Investigations in Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,CETER-Center for Epilepsy Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marina Amaral de Oliveira
- Basic Research and Advanced Investigations in Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Sheila Cristina Ouriques Martins
- Graduate Program in Medicine: Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marino Muxfeldt Bianchin
- Graduate Program in Medicine: Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Basic Research and Advanced Investigations in Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,CETER-Center for Epilepsy Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Chelluboina B, Vemuganti R. Chronic kidney disease in the pathogenesis of acute ischemic stroke. J Cereb Blood Flow Metab 2019; 39:1893-1905. [PMID: 31366298 PMCID: PMC6775591 DOI: 10.1177/0271678x19866733] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/25/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
Abstract
Chronic kidney disease has a graded and independent inverse impact on cerebrovascular health. Both thrombotic and hemorrhagic complications are highly prevalent in chronic kidney disease patients. Growing evidence suggests that in chronic kidney disease patients, ischemic strokes are more common than hemorrhagic strokes. Chronic kidney disease is asymptomatic until an advanced stage, but mild to moderate chronic kidney disease incites various pathogenic mechanisms such as inflammation, oxidative stress, neurohormonal imbalance, formation of uremic toxins and vascular calcification which damage the endothelium and blood vessels. Cognitive dysfunction, dementia, transient infarcts, and white matter lesions are widespread in mild to moderate chronic kidney disease patients. Uremic toxins produced after chronic kidney disease can pass through the blood-brain barrier and mediate cognitive dysfunction and neurodegeneration. Furthermore, chronic kidney disease precipitates vascular risk factors that can lead to atherosclerosis, hypertension, atrial fibrillation, and diabetes. Chronic kidney disease also exacerbates stroke pathogenesis, worsens recovery outcomes, and limits the eligibility of stroke patients to receive available stroke therapeutics. This review highlights the mechanisms involved in the advancement of chronic kidney disease and its possible association with stroke.
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Affiliation(s)
- Bharath Chelluboina
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
- William S. Middleton Veterans Administration Hospital, Madison, WI, USA
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Polymeris AA, Curtze S, Erdur H, Hametner C, Heldner MR, Groot AE, Zini A, Béjot Y, Dietrich A, Martinez-Majander N, von Rennenberg R, Gumbinger C, Schaedelin S, De Marchis GM, Thilemann S, Traenka C, Lyrer PA, Bonati LH, Wegener S, Ringleb PA, Tatlisumak T, Nolte CH, Scheitz JF, Arnold M, Strbian D, Nederkoorn PJ, Gensicke H, Engelter ST. Intravenous thrombolysis for suspected ischemic stroke with seizure at onset. Ann Neurol 2019; 86:770-779. [PMID: 31435960 DOI: 10.1002/ana.25582] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/06/2019] [Accepted: 08/18/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Seizure at onset (SaO) has been considered a relative contraindication for intravenous thrombolysis (IVT) in patients with acute ischemic stroke, although this appraisal is not evidence based. Here, we investigated the prognostic significance of SaO in patients treated with IVT for suspected ischemic stroke. METHODS In this multicenter, IVT-registry-based study we assessed the association between SaO and symptomatic intracranial hemorrhage (sICH, European Cooperative Acute Stroke Study II definition), 3-month mortality, and 3-month functional outcome on the modified Rankin Scale (mRS) using unadjusted and adjusted logistic regression, coarsened exact matching, and inverse probability weighted analyses. RESULTS Among 10,074 IVT-treated patients, 146 (1.5%) had SaO. SaO patients had significantly higher National Institutes of Health Stroke Scale score and glucose on admission, and more often female sex, prior stroke, and prior functional dependence than non-SaO patients. In unadjusted analysis, they had generally less favorable outcomes. After controlling for confounders in adjusted, matched, and weighted analyses, all associations between SaO and any of the outcomes disappeared, including sICH (odds ratio [OR]unadjusted = 1.53 [95% confidence interval (CI) = 0.74-3.14], ORadjusted = 0.52 [95% CI = 0.13-2.16], ORmatched = 0.68 [95% CI = 0.15-3.03], ORweighted = 0.95 [95% CI = 0.39-2.32]), mortality (ORunadjusted = 1.49 [95% CI = 1.00-2.24], ORadjusted = 0.98 [95% CI = 0.5-1.92], ORmatched = 1.13 [95% CI = 0.55-2.33], ORweighted = 1.17 [95% CI = 0.73-1.88]), and functional outcome (mRS ≥ 3/ordinal mRS: ORunadjusted = 1.33 [95% CI = 0.96-1.84]/1.35 [95% CI = 1.01-1.81], ORadjusted = 0.78 [95% CI = 0.45-1.32]/0.78 [95% CI = 0.52-1.16], ORmatched = 0.75 [95% CI = 0.43-1.32]/0.45 [95% CI = 0.10-2.06], ORweighted = 0.87 [95% CI = 0.57-1.34]/1.00 [95% CI = 0.66-1.52]). These results were consistent regardless of whether patients had an eventual diagnosis of ischemic stroke (89/146) or stroke mimic (57/146 SaO patients). INTERPRETATION SaO was not an independent predictor of poor prognosis. Withholding IVT from patients with assumed ischemic stroke presenting with SaO seems unjustified. ANN NEUROL 2019;86:770-779.
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Affiliation(s)
- Alexandros A Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hebun Erdur
- Department of Neurology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian Hametner
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Adrien E Groot
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrea Zini
- IRCCS Istituto di Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Yannick Béjot
- University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France
| | - Annina Dietrich
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | | | - Christoph Gumbinger
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine Schaedelin
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sebastian Thilemann
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Philippe A Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Turgut Tatlisumak
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christian H Nolte
- Department of Neurology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Department of Neurology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Daniel Strbian
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
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Incidence, Implications, and Management of Seizures Following Ischemic and Hemorrhagic Stroke. Curr Neurol Neurosci Rep 2019; 19:37. [PMID: 31134438 DOI: 10.1007/s11910-019-0957-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW In this review, we summarize the recent literature regarding the incidence and treatment of seizures arising after ischemic and hemorrhagic strokes. Additionally, we identify open questions in guidelines and standard clinical care to aid future studies aiming to improve management of seizures in post-stroke patients. RECENT FINDINGS Studies demonstrate an increasing prevalence of seizures following strokes, probably a consequence of advances in post-stroke management and expanding use of continuous EEG monitoring. Post-stroke seizures are associated with longer hospitalization and increased mortality; therefore, prevention and timely treatment of seizures are important. The standard of care is to treat recurrent seizures with anti-epileptic drugs (AEDs) regardless of the etiology. However, there are no established guidelines currently for prophylactic use of AEDs following a stroke. The prevalence of post-stroke seizures is increasing. Further studies are needed to determine the risk factors for recurrent seizures and epilepsy after strokes and optimal treatment strategies.
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28
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Lenoir S, Varangot A, Lebouvier L, Galli T, Hommet Y, Vivien D. Post-synaptic Release of the Neuronal Tissue-Type Plasminogen Activator (tPA). Front Cell Neurosci 2019; 13:164. [PMID: 31105531 PMCID: PMC6491899 DOI: 10.3389/fncel.2019.00164] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/08/2019] [Indexed: 11/13/2022] Open
Abstract
The neuronal serine protease tissue-type Plasminogen Activator (tPA) is an important player of the neuronal survival and of the synaptic plasticity. Thus, a better understanding the mechanisms regulating the neuronal trafficking of tPA is required to further understand how tPA can influence brain functions. Using confocal imaging including living cells and high-resolution cell imaging combined with an innovating labeling of tPA, we demonstrate that the neuronal tPA is contained in endosomal vesicles positives for Rabs and in exosomal vesicles positives for synaptobrevin-2 (VAMP2) in dendrites and axons. tPA-containing vesicles differ in their dynamics with the dendritic tPA containing-vesicles less mobile than the axonal tPA-containing vesicles, these laters displaying mainly a retrograde trafficking. Interestingly spontaneous exocytosis of tPA containing-vesicles occurs largely in dendrites.
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Affiliation(s)
- Sophie Lenoir
- Physiopathology and Imaging of Neurological Disorders, UNICAEN, INSERM, UMR-S U1237, Normandie Université, Caen, France
| | - Alexandre Varangot
- Physiopathology and Imaging of Neurological Disorders, UNICAEN, INSERM, UMR-S U1237, Normandie Université, Caen, France
| | - Laurent Lebouvier
- Physiopathology and Imaging of Neurological Disorders, UNICAEN, INSERM, UMR-S U1237, Normandie Université, Caen, France
| | - Thierry Galli
- Membrane Traffic in Healthy & Diseased Brain, Center of Psychiatry and Neurosciences, INSERM U894, Sorbonne Paris-Cité, Université Paris Descartes, Paris, France
| | - Yannick Hommet
- Physiopathology and Imaging of Neurological Disorders, UNICAEN, INSERM, UMR-S U1237, Normandie Université, Caen, France
| | - Denis Vivien
- Physiopathology and Imaging of Neurological Disorders, UNICAEN, INSERM, UMR-S U1237, Normandie Université, Caen, France.,Department of Clinical Research, Caen University Hospital, CHU Caen, Caen, France
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Anadani M, Lekoubou A, Almallouhi E, Alawieh A, Chatterjee A, Vargas J, Spiotta AM. Incidence, predictors, and outcome of early seizures after mechanical thrombectomy. J Neurol Sci 2018; 396:235-239. [PMID: 30529800 DOI: 10.1016/j.jns.2018.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/04/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Despite the wide utilization of mechanical thrombectomy (MT) for acute ischemic stroke treatment, little is known about the incidence of early post-thrombectomy seizures, its predictors, and association with long-term outcome. METHODS Using a prospective registry of mechanical thrombectomy in ischemic stroke between January 2013 and July 2017, we identified patients who developed a seizure within 7 days (early seizure) of qualifying event. Backward stepwise regression analysis was used to assess independent predictors of seizure occurrence and the association between seizure and functional outcome (modified Rankin scale of 0-2 vs. ≥3). RESULTS A total of 459 patients were included in the final analysis. Mean age was 67.5 (SD 15.1), and 49.9% of patients were female. Successful recanalization (TICI≥2B) was achieved in 92.8% of patients. Eleven (2.4%) patients developed at least one seizure. Only an Alberta Stroke Program Early CT (ASPECT) score of <6 was independently associated with the occurrence of early seizures [Odds ratio, 95% confidence interval: 8.188, (2.219-30.214); P = .002]. On multivariate analysis, early seizures were associated with 90-day mortality rate [OR,6.487; 95% confidence interval, (1.481-28.405); P = .013] and poor functional outcome (OR, 4.7; 95% confidence interval (1.08-20.83); p = .039). CONCLUSION In the studied cohort, 2.4% of ischemic stroke patients treated with MT developed at least one seizure within 7 days of stroke onset. A low ASPECT score was associated with the occurrence of early seizures. The occurrence of seizures was associated with 90-day mortality and poor functional outcome.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - Alain Lekoubou
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Eyad Almallouhi
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Ali Alawieh
- Department of Neurosurgery, Medical University of South Carolina Charleston, SC, USA
| | - Arindam Chatterjee
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Jan Vargas
- Department of Neurosurgery, Medical University of South Carolina Charleston, SC, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina Charleston, SC, USA
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Thiebaut AM, Gauberti M, Ali C, Martinez De Lizarrondo S, Vivien D, Yepes M, Roussel BD. The role of plasminogen activators in stroke treatment: fibrinolysis and beyond. Lancet Neurol 2018; 17:1121-1132. [PMID: 30507392 DOI: 10.1016/s1474-4422(18)30323-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/25/2018] [Accepted: 08/28/2018] [Indexed: 12/20/2022]
Abstract
Although recent technical advances in thrombectomy have revolutionised acute stroke treatment, prevalence of disability and death related to stroke remain high. Therefore, plasminogen activators-eukaryotic, bacterial, or engineered forms that can promote fibrinolysis by converting plasminogen into active plasmin and facilitate clot breakdown-are still commonly used in the acute treatment of ischaemic stroke. Hence, plasminogen activators have become a crucial area for clinical investigation for their ability to recanalise occluded arteries in ischaemic stroke and to accelerate haematoma clearance in haemorrhagic stroke. However, inconsistent results, insufficient evidence of efficacy, or reports of side-effects in trial settings might reduce the use of plasminogen activators in clinical practice. Additionally, the mechanism of action for plasminogen activators could extend beyond the vessel lumen and involve plasminogen-independent processes, which would suggest that plasminogen activators have also non-fibrinolytic roles. Understanding the complex mechanisms of action of plasminogen activators can guide future directions for therapeutic interventions in patients with stroke.
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Affiliation(s)
- Audrey M Thiebaut
- Normandie Université, UNICAEN, INSERM, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, Cyceron, Caen, France
| | - Maxime Gauberti
- Normandie Université, UNICAEN, INSERM, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, Cyceron, Caen, France
| | - Carine Ali
- Normandie Université, UNICAEN, INSERM, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, Cyceron, Caen, France
| | - Sara Martinez De Lizarrondo
- Normandie Université, UNICAEN, INSERM, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, Cyceron, Caen, France
| | - Denis Vivien
- Normandie Université, UNICAEN, INSERM, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, Cyceron, Caen, France; Clinical Research Department, University Hospital Caen-Normandy, Caen, France
| | - Manuel Yepes
- Department of Neurology and Center for Neurodegenerative Disease, Emory University School of Medicine, Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, and Department of Neurology, Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Benoit D Roussel
- Normandie Université, UNICAEN, INSERM, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, Cyceron, Caen, France.
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31
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Strambo D, Rey V, Rossetti AO, Maeder P, Dunet V, Browaeys P, Michel P. Perfusion-CT imaging in epileptic seizures. J Neurol 2018; 265:2972-2979. [DOI: 10.1007/s00415-018-9095-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
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Feyissa AM, Hasan TF, Meschia JF. Stroke-related epilepsy. Eur J Neurol 2018; 26:18-e3. [PMID: 30320425 DOI: 10.1111/ene.13813] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/19/2018] [Indexed: 01/16/2023]
Abstract
Stroke is the cause of about 10% of all epilepsy and 55% of newly diagnosed seizures among the elderly. Although recent advances in acute stroke therapy have improved longevity, there has been a consequent rise in the prevalence of stroke-related epilepsy (STRE). Many clinical studies make a distinction between early (within 7 days of onset of stroke) and late (beyond 7 days of onset of stroke) seizures based on presumed pathophysiological differences. Although early seizures are thought to be the consequence of local metabolic disturbances without altered neuronal networks, late seizures are thought to occur when the brain has acquired a predisposition for seizures. Overall, STRE has a good prognosis, being well controlled by antiepileptic drugs. However, up to 25% of cases become drug resistant. STRE can also result in increased morbidity, longer hospitalization, greater disability at discharge and greater resource utilization. Additional controlled trials are needed to explore the primary and secondary prevention of STRE as well as to provide high-quality evidence on efficacy and tolerability of antiepileptic drugs to guide treatment of STRE. Robust pre-clinical and clinical prediction models of STRE are also needed to develop treatments to prevent the transformation of infarcted tissue into an epileptic focus.
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Affiliation(s)
- A M Feyissa
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - T F Hasan
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - J F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
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Farrokh S, Tahsili-Fahadan P, Ritzl EK, Lewin JJ, Mirski MA. Antiepileptic drugs in critically ill patients. Crit Care 2018; 22:153. [PMID: 29880020 PMCID: PMC5992651 DOI: 10.1186/s13054-018-2066-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of seizures in intensive care units ranges from 3.3% to 34%. It is therefore often necessary to initiate or continue anticonvulsant drugs in this setting. When a new anticonvulsant is initiated, drug factors, such as onset of action and side effects, and patient factors, such as age, renal, and hepatic function, should be taken into account. It is important to note that the altered physiology of critically ill patients as well as pharmacological and nonpharmacological interventions such as renal replacement therapy, extracorporeal membrane oxygenation, and target temperature management may lead to therapeutic failure or toxicity. This may be even more challenging with the availability of newer antiepileptics where the evidence for their use in critically ill patients is limited. MAIN BODY This article reviews the pharmacokinetics and pharmacodynamics of antiepileptics as well as application of these principles when dosing antiepileptics and monitoring serum levels in critically ill patients. The selection of the most appropriate anticonvulsant to treat seizure and status epileptics as well as the prophylactic use of these agents in this setting are also discussed. Drug-drug interactions and the effect of nonpharmacological interventions such as renal replacement therapy, plasma exchange, and extracorporeal membrane oxygenation on anticonvulsant removal are also included. CONCLUSION Optimal management of antiepileptic drugs in the intensive care unit is challenging given altered physiology, polypharmacy, and nonpharmacological interventions, and requires a multidisciplinary approach where appropriate and timely assessment, diagnosis, treatment, and monitoring plans are in place.
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Affiliation(s)
- Salia Farrokh
- Department of Pharmacy, The Johns Hopkins Hospital, 600 N. Wolfe Street, Carnegie 180, Baltimore, MD 21287 USA
| | - Pouya Tahsili-Fahadan
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD USA
- Department of Medicine, Virginia Commonwealth University School of Medicine, INOVA Campus, Falls Church, VA USA
| | - Eva K. Ritzl
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD USA
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD USA
| | - John J. Lewin
- Department of Pharmacy, The Johns Hopkins Hospital, 600 N. Wolfe Street, Carnegie 180, Baltimore, MD 21287 USA
| | - Marek A. Mirski
- Department of Pharmacy, The Johns Hopkins Hospital, 600 N. Wolfe Street, Carnegie 180, Baltimore, MD 21287 USA
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Naylor J, Thevathasan A, Churilov L, Guo R, Xiong Y, Koome M, Chen Z, Chen Z, Liu X, Kwan P, Campbell BCV. Association between different acute stroke therapies and development of post stroke seizures. BMC Neurol 2018; 18:61. [PMID: 29724190 PMCID: PMC5932812 DOI: 10.1186/s12883-018-1064-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background Epilepsy is a major complication of stroke. We aimed to establish whether there is an association between intravenous thrombolysis, intra-arterial thrombolysis and post stroke seizure (PSS) development. Improved understanding of the relationship between reperfusion therapies and seizure development may improve post-stroke monitoring and follow-up. Methods This was a retrospective, multicentre cohort study conducted at the Royal Melbourne Hospital and Jingling Hospital Nanjing. We included patients with anterior circulation ischemic stroke admitted 2008–2015. Patients were divided into four treatment groups 1. IV-tPA only, 2. Intra-arterial therapies (IAT) only, 3. IAT + IV-tPA and 4. stroke unit care only (i.e. no IV-tPA or IAT). To assess the association between type of reperfusion treatment and seizure incidence we used multivariable logistic regression models adjusted for age, stroke severity, 3-month functional outcome and prognostic factors. Results There were 1375 stroke unit care-only patients, of whom 28 (2%) developed PSS. There were 363 patients who received only IV-tPA, of whom 21 (5.8%) developed PSS. There were 93 patients who received IAT only, of whom 12 (12.9%) developed PSS and 112 that received both IV-tPA + IAT, of which 5 (4.5%) developed PSS. All reperfusion treatments were associated with seizure development compared to stroke unit care-only patients: IV-tPA only adjusted odds ratio (aOR) 3.7, 95%CI 1.8–7.4, p < 0.0001; IAT aOR 5.5, 95%CI 2.1–14.3, p < 0.0001, IAT + IV-tPA aOR 3.4, 95% CI 0.98–11.8, p = 0.05. These aORs did not differ significantly between treatment groups (IV-tPA + IAT versus IV-tPA p = 0.89, IV-tPA + IAT versus IAT, p = 0.44). Conclusions Patients receiving thrombolytic or intra-arterial reperfusion therapies for acute ischemic stroke are at higher risk of epilepsy and may benefit from longer follow-up. No evidence for an additive or synergistic effect of treatment modality on seizure development was found. Electronic supplementary material The online version of this article (10.1186/s12883-018-1064-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jillian Naylor
- Melbourne Brain Centre, Royal Melbourne Hospital and Department of Neurology, University of Melbourne, Parkville, Melbourne, Australia. .,Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
| | - Arthur Thevathasan
- Melbourne Brain Centre, Royal Melbourne Hospital and Department of Neurology, University of Melbourne, Parkville, Melbourne, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Heath, University of Melbourne, Parkville, Melbourne, Australia
| | - Ruibing Guo
- Department of Neurology, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yunyun Xiong
- Department of Neurology, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Miriam Koome
- Melbourne Brain Centre, Royal Melbourne Hospital and Department of Neurology, University of Melbourne, Parkville, Melbourne, Australia
| | - Ziyi Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziyuan Chen
- Melbourne Brain Centre, Royal Melbourne Hospital and Department of Neurology, University of Melbourne, Parkville, Melbourne, Australia
| | - Xinfeng Liu
- Department of Neurology, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Patrick Kwan
- Melbourne Brain Centre, Royal Melbourne Hospital and Department of Neurology, University of Melbourne, Parkville, Melbourne, Australia
| | - Bruce C V Campbell
- Melbourne Brain Centre, Royal Melbourne Hospital and Department of Neurology, University of Melbourne, Parkville, Melbourne, Australia
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Chen Z, Churilov L, Chen Z, Naylor J, Koome M, Yan B, Kwan P. Association between implementation of a code stroke system and poststroke epilepsy. Neurology 2018; 90:e1126-e1133. [DOI: 10.1212/wnl.0000000000005212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023] Open
Abstract
ObjectiveWe aimed to investigate the effect of a code stroke system on the development of poststroke epilepsy.MethodsWe retrospectively analyzed consecutive patients treated with IV thrombolysis under or outside the code stroke system between 2003 and 2012. Patients were followed up for at least 2 years or until death. Factors with p < 0.1 in univariate comparisons were selected for multivariable logistic and Cox regression.ResultsA total of 409 patients met the eligibility criteria. Their median age at stroke onset was 75 years (interquartile range 64–83 years); 220 (53.8%) were male. The median follow-up duration was 1,074 days (interquartile range 119–1,671 days). Thirty-two patients (7.8%) had poststroke seizures during follow-up, comprising 7 (1.7%) with acute symptomatic seizures and 25 (6.1%) with late-onset seizures. Twenty-six patients (6.4%) fulfilled the definition of poststroke epilepsy. Three hundred eighteen patients (77.8%) were treated with the code stroke system while 91 (22.2%) were not. After adjustment for age and stroke etiology, use of the code stroke system was associated with decreased odds of poststroke epilepsy (odds ratio = 0.36, 95% confidence interval 0.14–0.87, p = 0.024). Cox regression showed lower adjusted hazard rates for poststroke epilepsy within 5 years for patients managed under the code stroke system (hazard ratio = 0.60, 95% confidence interval 0.47–0.79, p < 0.001).ConclusionThe code stroke system was associated with reduced odds and instantaneous risk of poststroke epilepsy. Further studies are required to identify the contribution of the individual components and mechanisms against epileptogenesis after stroke.Classification of evidenceThis study provides Class III evidence that for people with acute ischemic stroke, implementation of a code stroke system reduces the risk of poststroke epilepsy.
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Challenges in the Anesthetic and Intensive Care Management of Acute Ischemic Stroke. J Neurosurg Anesthesiol 2017; 28:214-32. [PMID: 26368664 DOI: 10.1097/ana.0000000000000225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Acute ischemic stroke (AIS) is a devastating condition with high morbidity and mortality. In the past 2 decades, the treatment of AIS has been revolutionized by the introduction of several interventions supported by class I evidence-care on a stroke unit, intravenous tissue plasminogen activator within 4.5 hours of stroke onset, aspirin commenced within 48 hours of stroke onset, and decompressive craniectomy for supratentorial malignant hemispheric cerebral infarction. There is new class I evidence also demonstrating benefits of endovascular therapy on functional outcomes in those with anterior circulation stroke. In addition, the importance of the careful management of key systemic physiological variables, including oxygenation, blood pressure, temperature, and serum glucose, has been appreciated. In line with this, the role of anesthesiologists and intensivists in managing AIS has increased. This review highlights the main challenges in the endovascular and intensive care management of AIS that, in part, result from the paucity of research focused on these areas. It also provides guidelines for the management of AIS based upon current evidence, and identifies areas for further research.
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Lekoubou A, Awoumou JJ, Kengne AP. Incidence of seizure in stroke patients treated with recombinant tissue plasminogen activator: A systematic review and meta-analysis. Int J Stroke 2017; 12:923-931. [DOI: 10.1177/1747493017729239] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Recombinant tissue plasminogen activator is the only FDA-approved thrombolytic agent for acute stroke treatment. However, there are concerns that recombinant tissue plasminogen activator may increase the risk of seizures (including early and late seizures). Aims We performed a systematic review to assess the incidence of seizures and the association of recombinant tissue plasminogen activator with seizure occurrence. Summary of review We searched major databases for articles published between 1995 and February 2016. The pooled incidence of post-stroke seizure, early seizure, late seizure, and seizures sub-types was estimated overall and by status for recombinant tissue plasminogen activator treatment, and unadjusted odds ratio used to quantify the effects of recombinant tissue plasminogen activator on post-stroke seizure occurrence. In all, 4362 stroke participants were included with 49–63% being male and median age ranging from 68 to 71 years. A total of 792 received recombinant tissue plasminogen activator. The incidence of post-stroke seizure per 1000 participants (95% CI) was 95 (31–196) overall, 113 (49–202) in recombinant tissue plasminogen activator and 169 (6–326) in non-recombinant tissue plasminogen activator-treated (all heterogeneity- p<0.0001). Incidence of early seizure per 1000 (95% CI) was 35 (27–45) overall; 34 (22–50) among recombinant tissue plasminogen activator-treated patients, and 36 (25–48) among recombinant tissue plasminogen activator naïve participants (all heterogeneity- p > 0.826). The pool incidence rate per 1000 (95% CI) of late seizure was 84 (4–263), 46 (2–145), and 212 (184–241), respectively, in the overall, the recombinant tissue plasminogen activator-treated group and non-recombinant tissue plasminogen activator-treated group (heterogeneity for overall and recombinant tissue plasminogen activator-treated group < 0.0001, non-recombinant tissue plasminogen activator naïve = 0.999). The pooled odds ratio for post-stroke seizure (recombinant tissue plasminogen activator vs. no recombinant tissue plasminogen activator) was 0.94 (95% CI: 0. 17–5.26, heterogeneity- p < 0.0001). The pooled incidence per 1000 participants (95% CI) was 30 (0–144), 17 (2–49), 16 (2–44), and 9 (0–50), respectively, for focal seizure without impairment of consciousness, focal seizure with impairment of consciousness, generalized convulsive seizure, and status epilepticus; all heterogeneity- p < 0.0003. Accompanying pooled odds ratio (recombinant tissue plasminogen activator vs. no recombinant tissue plasminogen activator) based on one study was always in favor of non-significantly lower risk in recombinant tissue plasminogen activator-treated patients (all heterogeneity- p = 1). There were insufficient data to compute pooled odds ratio for early and late seizure. Conclusions Seizures affect nearly 1 out of every 10 stroke patients with inconclusive suggestion that rates are similar in recombinant tissue plasminogen activator-treated and recombinant tissue plasminogen activator naïve patients. Large prospective studies are needed to better understand the relationship between recombinant tissue plasminogen activator and post-stroke seizure occurrence.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | | - André Pascal Kengne
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council of South Africa, Cape Town, South Africa
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Wang JZ, Vyas MV, Saposnik G, Burneo JG. Incidence and management of seizures after ischemic stroke. Neurology 2017; 89:1220-1228. [DOI: 10.1212/wnl.0000000000004407] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/29/2017] [Indexed: 02/03/2023] Open
Abstract
Objective:We conducted a meta-analysis of the incidence of early and late seizures following ischemic stroke as well as a systematic review of their pharmacologic treatment.Methods:Observational studies that reported incidence of seizures following ischemic stroke and those that reported treatment response to any particular antiepileptic drugs (AEDs) were included. Risk of bias was assessed by predefined study characteristics. Random effects meta-analysis was conducted for all studies where data were available for the incidence of early and late stroke-related seizures. Heterogeneity was measured with I2 statistic and sensitivity analyses were performed using prespecified variables. A qualitative synthesis of studies reporting use of AEDs for stroke-related seizures was performed.Results:Forty-one studies from 10,554 articles were identified; 35 studies reported incidence of stroke-related seizures and 6 studies reported effects of specific AEDs. Most studies were of low to moderate quality. Rate of early seizures was 3.3% (95% confidence interval 2.8%–3.9%, I2 = 92.8%), while the incidence of late seizures or epilepsy was 18 per 1,000 person-years (95% confidence interval 1.5–2.2, I2 = 94.1%). The high degree of heterogeneity could not be explained from the sensitivity analyses. For management of stroke-related seizures, no single AED was found to be more effective over others, though newer AEDs were associated with fewer side effects.Conclusions:The burden of stroke-related seizures and epilepsy due to ischemic stroke is substantial. Further studies are required to determine risk factors for epilepsy following ischemic stroke and optimal secondary prevention.
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Can the benefits of rtPA treatment for stroke be improved? Rev Neurol (Paris) 2017; 173:566-571. [PMID: 28797689 DOI: 10.1016/j.neurol.2017.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/02/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
Abstract
Tissue-type plasminogen activator (tPA) is a serine protease well known to promote fibrinolysis. This is why: its recombinant form (rtPA) can be used, either alone or combined with thrombectomy, to promote recanalization/reperfusion following ischemic stroke. However, its overall benefits are counteracted by some of its side-effects, including incomplete lysis of clots, an increased risk of hemorrhagic transformation and the possibility of neurotoxicity. Nevertheless, better understanding of the mechanisms by which tPA influences brain function and promotes its alteration may help in the design of new strategies to improve stroke therapy.
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Xu Y, Hackett ML, Chalmers J, Lindley RI, Wang X, Li Q, Robinson T, Arima H, Lavados PM, Anderson CS. Frequency, determinants, and effects of early seizures after thrombolysis for acute ischemic stroke: The ENCHANTED trial. Neurol Clin Pract 2017; 7:324-332. [PMID: 29185557 DOI: 10.1212/cpj.0000000000000384] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022]
Abstract
Background Seizures after ischemic stroke have not been well-studied. We aim to determine the frequency, determinants, and significance of early seizures after thrombolysis for acute ischemic stroke. Methods Data are from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), an international, multicenter, randomized controlled trial where patients with acute ischemic stroke were randomized to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) IV alteplase. The protocol prespecified prospective data collection on in-hospital seizures over 7 days postrandomization. Logistic regression models were used to determine variables associated with seizures and their significance on poor outcomes of death or disability (modified Rankin scale scores 3-6), symptomatic intracerebral hemorrhage (sICH), and European Quality of Life 5-Dimensions questionnaire [EQ-5D] over 90 days. Results Data were available for 3,139 acute ischemic stroke participants, of whom 42 (1.3%) had seizures at a median 22.7 hours after the onset of symptoms. Baseline variables associated with seizures were male sex (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.07-4.50), severe neurologic impairment (NIH Stroke Scale score ≥10; OR 2.16, 95% CI 1.06-4.40), and fever (OR 4.55, 95% CI 2.37-8.71). Seizures independently predicted poor recovery: death or major disability (OR 2.88, 95% CI 1.28-6.47), unfavorable ordinal shift of mRS scores (OR 1.94, 95% CI 1.10-3.39), and lower than median EQ-5D health utility index score (OR 3.50, 95% CI 1.37-8.91). There was no association of seizures with sICH in adjusted analysis. Conclusions In thrombolysis-treated patients with acute ischemic stroke, seizures are uncommon, occur early, and predict poor recovery. Clinicaltrialsgov identifier NCT01422616.
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Affiliation(s)
- Ying Xu
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
| | - Maree L Hackett
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
| | - John Chalmers
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
| | - Richard I Lindley
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
| | - Xia Wang
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
| | - Qiang Li
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
| | - Thompson Robinson
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
| | - Hisatomi Arima
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
| | - Pablo M Lavados
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
| | - Craig S Anderson
- The George Institute for Global Health (YX, MLH, JC, RIL, XW, QL, HA, CSA), University of New South Wales; Sydney Medical School (YX, MLH, JC, RIL, CSA), the University of Sydney, Australia; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (TR), University of Leicester, UK; Department of Preventive Medicine and Public Health (HA), Faculty of Medicine, Fukuoka University, Japan; Clinica Alemana de Santiago, Facultad de Medicina (PML), Clinica Alemana Universidad del Desarrollo; Departamento de Ciencias Neurológicas (PML), Facultad de Medicina, Universidad de Chile, Santiago; Neurology Department (CSA), Royal Prince Alfred Hospital, Sydney, Australia; and The George Institute China at Peking University Health Science Center (CSA), Beijing PR China
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Bentes C, Martins H, Peralta AR, Morgado C, Casimiro C, Franco AC, Fonseca AC, Geraldes R, Canhão P, Pinho e Melo T, Paiva T, Ferro JM. Epileptic manifestations in stroke patients treated with intravenous alteplase. Eur J Neurol 2017; 24:755-761. [DOI: 10.1111/ene.13292] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/06/2017] [Indexed: 01/19/2023]
Affiliation(s)
- C. Bentes
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - H. Martins
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - A. R. Peralta
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - C. Morgado
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - C. Casimiro
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - A. C. Franco
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - A. C. Fonseca
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - R. Geraldes
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - P. Canhão
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - T. Pinho e Melo
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - T. Paiva
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
| | - J. M. Ferro
- Department of Neurosciences and Mental Health (Neurology); Hospital de Santa Maria-CHLN; Lisboa Portugal
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Leys D, Hommet Y, Jacquet C, Moulin S, Sibon I, Mas JL, Moulin T, Giroud M, Sagnier S, Cordonnier C, Medeiros de Bustos E, Turc G, Ronzière T, Bejot Y, Detante O, Ouk T, Mendyk AM, Favrole P, Zuber M, Triquenot-Bagan A, Ozkul-Wermester O, Montoro FM, Lamy C, Faivre A, Lebouvier L, Potey C, Poli M, Hénon H, Renou P, Dequatre-Ponchelle N, Bodenant M, Debruxelles S, Rossi C, Bordet R, Vivien D. Proportion of single-chain recombinant tissue plasminogen activator and outcome after stroke. Neurology 2016; 87:2416-2426. [DOI: 10.1212/wnl.0000000000003399] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/30/2016] [Indexed: 11/15/2022] Open
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Bonaventura A, Montecucco F, Dallegri F. Update on the effects of treatment with recombinant tissue-type plasminogen activator (rt-PA) in acute ischemic stroke. Expert Opin Biol Ther 2016; 16:1323-1340. [PMID: 27548625 DOI: 10.1080/14712598.2016.1227779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Acute ischemic stroke (AIS) represents a major cause of death and disability all over the world. The recommended therapy aims at dissolving the clot to re-establish quickly the blood flow to the brain and reduce neuronal injury. Intravenous administration of recombinant tissue-type plasminogen activator (rt-PA) is clinically used with this goal. AREAS COVERED A description of beneficial and detrimental effects of rt-PA treatment is addressed. An overview of new therapies against AIS, such as new thrombolytics, sonolysis and sonothrombolysis, endovascular procedures, and association therapies is provided. Updates on the pathophysiological process leading to intracranial hemorrhage (ICH) is also discussed. EXPERT OPINION rt-PA treatment in AIS patients is beneficial to recovery outcomes. To weaken risks and improve benefits, it might be relevant to consider: i) a definitive identification of risk factors for symptomatic ICH; ii). a better organization of the health care system to reduce time-to-treatment and enhance discharge management. The pharmacological improvement of new thrombolytic drugs (such as tenecteplase and desmoteplase) targeting harmful and maximally exploiting beneficial effects might further reduce mortality and disability in AIS.
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Affiliation(s)
- Aldo Bonaventura
- a First Clinic of Internal Medicine, Department of Internal Medicine , University of Genoa School of Medicine , Genoa , Italy.,b IRCCS AOU San Martino - IST, Genoa , Genoa , Italy
| | - Fabrizio Montecucco
- a First Clinic of Internal Medicine, Department of Internal Medicine , University of Genoa School of Medicine , Genoa , Italy.,b IRCCS AOU San Martino - IST, Genoa , Genoa , Italy.,c Centre of Excellence for Biomedical Research (CEBR) , University of Genoa , Genoa , Italy
| | - Franco Dallegri
- a First Clinic of Internal Medicine, Department of Internal Medicine , University of Genoa School of Medicine , Genoa , Italy.,b IRCCS AOU San Martino - IST, Genoa , Genoa , Italy
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Hébert M, Lesept F, Vivien D, Macrez R. The story of an exceptional serine protease, tissue-type plasminogen activator (tPA). Rev Neurol (Paris) 2015; 172:186-97. [PMID: 26626577 DOI: 10.1016/j.neurol.2015.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 10/04/2015] [Indexed: 12/17/2022]
Abstract
The only acute treatment of ischemic stroke approved by the health authorities is tissue recombinant plasminogen activator (tPA)-induced thrombolysis. Under physiological conditions, tPA, belonging to the serine protease family, is secreted by endothelial and brain cells (neurons, astrocytes, microglia, oligodendrocytes). Although revascularisation induced by tPA is beneficial during a stroke, research over the past 20 years shows that tPA can also be deleterious for the brain parenchyma. Thus, in this review of the literature, after a brief history on the discovery of tPA, we reviewed current knowledge of mechanisms by which tPA can influence brain function in physiological and pathological conditions.
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Affiliation(s)
- M Hébert
- Inserm, UMR-S U919 serine proteases and pathophysiology of the neurovascular unit, 14000 Caen, France
| | - F Lesept
- Inserm, UMR-S U919 serine proteases and pathophysiology of the neurovascular unit, 14000 Caen, France
| | - D Vivien
- Inserm, UMR-S U919 serine proteases and pathophysiology of the neurovascular unit, 14000 Caen, France
| | - R Macrez
- Inserm, UMR-S U919 serine proteases and pathophysiology of the neurovascular unit, 14000 Caen, France.
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Pitkänen A, Roivainen R, Lukasiuk K. Development of epilepsy after ischaemic stroke. Lancet Neurol 2015; 15:185-197. [PMID: 26597090 DOI: 10.1016/s1474-4422(15)00248-3] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 12/20/2022]
Abstract
For about 30% of patients with epilepsy the cause is unknown. Even in patients with a known risk factor for epilepsy, such as ischaemic stroke, only a subpopulation of patients develops epilepsy. Factors that contribute to the risk for epileptogenesis in a given individual generally remain unknown. Studies in the past decade on epilepsy in patients with ischaemic stroke suggest that, in addition to the primary ischaemic injury, existing difficult-to-detect microscale changes in blood vessels and white matter present as epileptogenic pathologies. Injury severity, location and type of pathological changes, genetic factors, and pre-injury and post-injury exposure to non-genetic factors (ie, the exposome) can divide patients with ischaemic stroke into different endophenotypes with a variable risk for epileptogenesis. These data provide guidance for animal modelling of post-stroke epilepsy, and for laboratory experiments to explore with increased specificity the molecular 'mechanisms, biomarkers, and treatment targets of post-stroke epilepsy in different circumstances, with the aim of modifying epileptogenesis after ischaemic stroke in individual patients without compromising recovery.
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Affiliation(s)
- Asla Pitkänen
- Department of Neurobiology, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Reina Roivainen
- Department of Neurology, Hyvinkää Hospital, Hyvinkää, Finland
| | - Katarzyna Lukasiuk
- The Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
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Lemarchand E, Maubert E, Haelewyn B, Ali C, Rubio M, Vivien D. Stressed neurons protect themselves by a tissue-type plasminogen activator-mediated EGFR-dependent mechanism. Cell Death Differ 2015; 23:123-31. [PMID: 26068590 DOI: 10.1038/cdd.2015.76] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 11/09/2022] Open
Abstract
In the central nervous system, tissue-type plasminogen activator (tPA) has been associated with both pro-death and prosurvival actions on neurons. In most cases, this has been related to exogenous tPA. In the present study, we addressed the influence of endogenous tPA. We first observed an increased transcription of tPA following either in vivo global brain ischemia in rats or in vitro oxygen glucose deprivation (OGD) on mice and rats hippocampal slices. Hippocampal slices from tPA-deficient mice were more sensitive to OGD than wild-type slices. Pharmacological approaches targeting the known receptors of tPA revealed that only the inhibition of phosphorylation of epidermal growth factor receptors (EGFRs) prevented the neuroprotective effect of endogenous tPA. This study shows that ischemic hippocampal neurons overproduce endogenous tPA as an intend to protect themselves from ischemic death, by a mechanism involving an activation of EGFRs. Thus, strategies contributing to promote either endogenous production of tPA or its associated EGFR-linked signaling pathway may have beneficial effects following brain injuries such as stroke.
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Affiliation(s)
- E Lemarchand
- INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, Bd Henri Becquerel, GIP Cyceron, Caen, France
| | - E Maubert
- INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, Bd Henri Becquerel, GIP Cyceron, Caen, France
| | - B Haelewyn
- ESRP (European Stroke Research Platform), Centre Universitaire de Ressources Biologiques (CURB), Université Caen Basse Normandie, Caen, France
| | - C Ali
- INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, Bd Henri Becquerel, GIP Cyceron, Caen, France
| | - M Rubio
- INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, Bd Henri Becquerel, GIP Cyceron, Caen, France
| | - D Vivien
- INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, Bd Henri Becquerel, GIP Cyceron, Caen, France
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Lemarchand E, Gauberti M, Martinez de Lizarrondo S, Villain H, Repessé Y, Montagne A, Vivien D, Ali C, Rubio M. Impact of alcohol consumption on the outcome of ischemic stroke and thrombolysis: role of the hepatic clearance of tissue-type plasminogen activator. Stroke 2015; 46:1641-50. [PMID: 25922513 DOI: 10.1161/strokeaha.114.007143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 03/23/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Tissue-type plasminogen activator (tPA) is the only acute treatment for ischemic stroke. Unfortunately, the benefit of tPA-driven thrombolysis is not systematic, and understanding the reasons for this is mandatory. The balance between beneficial and detrimental effects of tPA might explain the limited overall efficiency of thrombolysis. Here, we investigated whether this balance could be influenced by excessive alcohol intake. METHODS We used a murine model of thromboembolic stroke, coupled to an array of biochemical assays, near-infrared or magnetic resonance imaging scans, 2-photon microscopy, hydrodynamic transfections, and immunohistological techniques. RESULTS We found that 6 weeks of alcohol consumption (10% in drinking water) worsens ischemic lesions and cancels the beneficial effects of tPA-induced thrombolysis. We accumulate in vivo and in vitro evidence showing that this aggravation is correlated with a decrease in lipoprotein receptor-related protein 1-mediated hepatic clearance of tPA in alcohol-exposed mice. CONCLUSIONS An efficient liver-driven clearance of tPA might influence the safety of thrombolysis after stroke.
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Affiliation(s)
- Eloïse Lemarchand
- From the INSERM UMR-S U919 "serine proteases and pathophysiology of the neurovascular unit" - SP2U Université Caen Basse-Normandie, GIP CYCERON, Caen, France (E.L., M.G., S.M.d.L., H.V., Y.R., A.M., D.V., C.A., M.R.); Service d'Hématologie CHU Caen, France (Y.R.); and Délégation Recherche Clinique et Innovation (DRCI), CHU de Caen, Caen, France (M.R.)
| | - Maxime Gauberti
- From the INSERM UMR-S U919 "serine proteases and pathophysiology of the neurovascular unit" - SP2U Université Caen Basse-Normandie, GIP CYCERON, Caen, France (E.L., M.G., S.M.d.L., H.V., Y.R., A.M., D.V., C.A., M.R.); Service d'Hématologie CHU Caen, France (Y.R.); and Délégation Recherche Clinique et Innovation (DRCI), CHU de Caen, Caen, France (M.R.)
| | - Sara Martinez de Lizarrondo
- From the INSERM UMR-S U919 "serine proteases and pathophysiology of the neurovascular unit" - SP2U Université Caen Basse-Normandie, GIP CYCERON, Caen, France (E.L., M.G., S.M.d.L., H.V., Y.R., A.M., D.V., C.A., M.R.); Service d'Hématologie CHU Caen, France (Y.R.); and Délégation Recherche Clinique et Innovation (DRCI), CHU de Caen, Caen, France (M.R.)
| | - Hélène Villain
- From the INSERM UMR-S U919 "serine proteases and pathophysiology of the neurovascular unit" - SP2U Université Caen Basse-Normandie, GIP CYCERON, Caen, France (E.L., M.G., S.M.d.L., H.V., Y.R., A.M., D.V., C.A., M.R.); Service d'Hématologie CHU Caen, France (Y.R.); and Délégation Recherche Clinique et Innovation (DRCI), CHU de Caen, Caen, France (M.R.)
| | - Yohann Repessé
- From the INSERM UMR-S U919 "serine proteases and pathophysiology of the neurovascular unit" - SP2U Université Caen Basse-Normandie, GIP CYCERON, Caen, France (E.L., M.G., S.M.d.L., H.V., Y.R., A.M., D.V., C.A., M.R.); Service d'Hématologie CHU Caen, France (Y.R.); and Délégation Recherche Clinique et Innovation (DRCI), CHU de Caen, Caen, France (M.R.)
| | - Axel Montagne
- From the INSERM UMR-S U919 "serine proteases and pathophysiology of the neurovascular unit" - SP2U Université Caen Basse-Normandie, GIP CYCERON, Caen, France (E.L., M.G., S.M.d.L., H.V., Y.R., A.M., D.V., C.A., M.R.); Service d'Hématologie CHU Caen, France (Y.R.); and Délégation Recherche Clinique et Innovation (DRCI), CHU de Caen, Caen, France (M.R.)
| | - Denis Vivien
- From the INSERM UMR-S U919 "serine proteases and pathophysiology of the neurovascular unit" - SP2U Université Caen Basse-Normandie, GIP CYCERON, Caen, France (E.L., M.G., S.M.d.L., H.V., Y.R., A.M., D.V., C.A., M.R.); Service d'Hématologie CHU Caen, France (Y.R.); and Délégation Recherche Clinique et Innovation (DRCI), CHU de Caen, Caen, France (M.R.)
| | - Carine Ali
- From the INSERM UMR-S U919 "serine proteases and pathophysiology of the neurovascular unit" - SP2U Université Caen Basse-Normandie, GIP CYCERON, Caen, France (E.L., M.G., S.M.d.L., H.V., Y.R., A.M., D.V., C.A., M.R.); Service d'Hématologie CHU Caen, France (Y.R.); and Délégation Recherche Clinique et Innovation (DRCI), CHU de Caen, Caen, France (M.R.)
| | - Marina Rubio
- From the INSERM UMR-S U919 "serine proteases and pathophysiology of the neurovascular unit" - SP2U Université Caen Basse-Normandie, GIP CYCERON, Caen, France (E.L., M.G., S.M.d.L., H.V., Y.R., A.M., D.V., C.A., M.R.); Service d'Hématologie CHU Caen, France (Y.R.); and Délégation Recherche Clinique et Innovation (DRCI), CHU de Caen, Caen, France (M.R.).
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Docagne F, Parcq J, Lijnen R, Ali C, Vivien D. Understanding the Functions of Endogenous and Exogenous Tissue-Type Plasminogen Activator During Stroke. Stroke 2015; 46:314-20. [DOI: 10.1161/strokeaha.114.006698] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fabian Docagne
- From the INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, GIP Cyceron, Caen, France (F.D., J.P., C.A., D.V.); and Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium (R.L.)
| | - Jérôme Parcq
- From the INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, GIP Cyceron, Caen, France (F.D., J.P., C.A., D.V.); and Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium (R.L.)
| | - Roger Lijnen
- From the INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, GIP Cyceron, Caen, France (F.D., J.P., C.A., D.V.); and Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium (R.L.)
| | - Carine Ali
- From the INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, GIP Cyceron, Caen, France (F.D., J.P., C.A., D.V.); and Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium (R.L.)
| | - Denis Vivien
- From the INSERM UMR-S U919 Serine Proteases and Pathophysiology of the Neurovascular Unit, Université Caen Basse Normandie, GIP Cyceron, Caen, France (F.D., J.P., C.A., D.V.); and Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium (R.L.)
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Bentes C, Peralta R, Viana P, Morgado C, Melo TP, Ferro JM. Cortical myoclonus during IV thrombolysis for ischemic stroke. EPILEPSY & BEHAVIOR CASE REPORTS 2014; 2:186-8. [PMID: 25667903 PMCID: PMC4307875 DOI: 10.1016/j.ebcr.2014.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/03/2014] [Accepted: 09/09/2014] [Indexed: 11/16/2022]
Abstract
We describe a patient with an acute middle cerebral artery ischemic stroke developing subtle involuntary movements of the paretic upper limb with cortical origin during rt-PA perfusion. Despite the multiple potential pathophysiological mechanisms for the relationship between thrombolysis and epileptic activity, seizures during this procedure are scarcely reported. Our hypothesis is that subtle and transient clinical seizures, like those described in our patient, may not be detected or are misdiagnosed as nonepileptic involuntary movements. We aimed to draw attention to the recognition challenge of this paroxysmal motor behavior, highlighting this clinical and neurophysiological identification using video recording and back-average analysis of the EEG.
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Affiliation(s)
- Carla Bentes
- Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal ; EEG/Sleep Laboratory, Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Rita Peralta
- Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal ; EEG/Sleep Laboratory, Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Pedro Viana
- Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Carlos Morgado
- Department of Neuroradiology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Teresa P Melo
- Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal ; Stroke Unit, Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - José M Ferro
- Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal ; Stroke Unit, Department of Neurology, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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