1
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Gruber J, Gattringer T, Mayr G, Schwarzenhofer D, Kneihsl M, Wagner J, Sonnberger M, Deutschmann H, Haidegger M, Fandler-Höfler S, Ropele S, Enzinger C, von Oertzen T. Frequency and predictors of poststroke epilepsy after mechanical thrombectomy for large vessel occlusion stroke: results from a multicenter cohort study. J Neurol 2023; 270:6064-6070. [PMID: 37658859 PMCID: PMC10632247 DOI: 10.1007/s00415-023-11966-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Poststroke epilepsy (PSE) represents an important complication of stroke. Data regarding the frequency and predictors of PSE in patients with large-vessel occlusion stroke receiving mechanical thrombectomy (MT) are scarce. Furthermore, information on acute and preexisting lesion characteristics on brain MRI has not yet been systematically considered in risk prediction of PSE. This study thus aims to assess PSE risk after acute ischemic stroke treated with MT, based on clinical and MRI features. METHODS In this multicenter study from two tertiary stroke centers, we included consecutive acute ischemic stroke patients who had received MT for acute intracranial large vessel occlusion (LVO) between 2011 and 2017, in whom post-interventional brain MRI and long term-follow-up data were available. Infarct size, affected cerebrovascular territory, hemorrhagic complications and chronic cerebrovascular disease features were assessed on MRI (blinded to clinical information). The primary outcome was the occurrence of PSE (> 7 days after stroke onset) assessed by systematic follow-up via phone interview or electronic records. RESULTS Our final study cohort comprised 348 thrombectomy patients (median age: 67 years, 45% women) with a median long-term follow-up of 78 months (range 0-125). 32 patients (9%) developed PSE after a median of 477 days (range 9-2577 days). In univariable analyses, larger postinterventional infarct size, infarct location in the parietal, frontal or temporal lobes and cerebral microbleeds were associated with PSE. Multivariable Cox regression analysis confirmed larger infarct size (HR 3.49; 95% CI 1.67-7.30) and presence of cerebral microbleeds (HR 2.56; 95% CI 1.18-5.56) as independent predictors of PSE. CONCLUSION In our study, patients with large vessel occlusion stroke receiving MT had a 9% prevalence of PSE over a median follow-up period of 6.5 years. Besides larger infarct size, presence of cerebral microbleeds on brain MRI predicted PSE occurrence.
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Affiliation(s)
- Joachim Gruber
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria.
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
| | - Georg Mayr
- Department of Neuroradiology, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Daniel Schwarzenhofer
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Judith Wagner
- Department of Neurology, Evangelisches Klinikum Gelsenkirchen, Academic Hospital University Essen-Duisburg, Gelsenkirchen, Germany
| | - Michael Sonnberger
- Department of Neuroradiology, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Melanie Haidegger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Simon Fandler-Höfler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Tim von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg-Weg 15, 4020, Linz, Austria.
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2
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Chen YS, Sung PS, Lai MC, Huang CW. The Primary Prevention of Poststroke Epilepsy in Patients With Middle Cerebral Artery Infarct: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49412. [PMID: 37999939 DOI: 10.2196/49412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Poststroke epilepsy poses a significant clinical challenge for individuals recovering from strokes, leading to a less favorable long-term outlook and increased mortality rates. Existing studies have primarily concentrated on administering antiseizure or anticonvulsant treatments only after the onset of late-onset seizures, without intervening during the epileptogenesis phase following a stroke. OBJECTIVE This research protocol is designed to conduct a randomized controlled trial to assess whether the early, preventive introduction of low-dose antiepileptic drug therapy (levetiracetam [LEV] or perampanel [PER]) in patients who have experienced middle cerebral artery (MCA) infarction can reduce the risk of developing poststroke epilepsy (primary prevention). METHODS Participants with MCA infarction, either with or without reperfusion treatments, will be recruited and promptly receive preventive intervention within 72 hours of the stroke occurrence. These participants will be randomly assigned to receive either PER (4 mg per day), LEV (1000 mg per day), or a placebo that matches the active drugs. This treatment will continue for 12 weeks after allocation. Brain magnetic resonance imaging will be used to confirm the presence of MCA territory infarction, and an electroencephalography will be used to ensure the absence of epileptiform discharges or electrographic seizures at the time of the stroke. All participants will undergo follow-up assessments for 72 weeks after allocation. RESULTS The primary outcome under evaluation will be the incidence of poststroke epilepsy in the 3 groups following the 18-month study period. Secondary outcomes will encompass the time to the occurrence of the first seizure, the severity of seizures, any treatment-related adverse events, and the modified Rankin scale score at 3 and 18 months. Exploratory outcomes will involve comparing the effectiveness and safety of PER and LEV. CONCLUSIONS We anticipate that the intervention groups will experience a lower incidence and reduced severity of poststroke epilepsy compared to the control group after 18 months. We aim to establish evidence supporting the potential preventive effects of LEV and PER on poststroke seizures and epilepsy in patients with MCA infarction, as well as to explore the antiepileptogenic potential of both LEV and PER in patients with major ischemic strokes. TRIAL REGISTRATION ClinicalTrials.gov NCT04858841; https://clinicaltrials.gov/study/NCT04858841. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49412.
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Affiliation(s)
- Yu-Shiue Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Chi Lai
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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3
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Misra S, Kasner SE, Dawson J, Tanaka T, Zhao Y, Zaveri HP, Eldem E, Vazquez J, Silva LS, Mohidat S, Hickman LB, Khan EI, Funaro MC, Nicolo JP, Mazumder R, Yasuda CL, Sunnerhagen KS, Ihara M, Ross JS, Liebeskind DS, Kwan P, Quinn TJ, Engel J, Mishra NK. Outcomes in Patients With Poststroke Seizures: A Systematic Review and Meta-Analysis. JAMA Neurol 2023; 80:1155-1165. [PMID: 37721736 PMCID: PMC10507596 DOI: 10.1001/jamaneurol.2023.3240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/21/2023] [Indexed: 09/19/2023]
Abstract
Importance Published data about the impact of poststroke seizures (PSSs) on the outcomes of patients with stroke are inconsistent and have not been systematically evaluated, to the authors' knowledge. Objective To investigate outcomes in people with PSS compared with people without PSS. Data Sources MEDLINE, Embase, PsycInfo, Cochrane, LILACS, LIPECS, and Web of Science, with years searched from 1951 to January 30, 2023. Study Selection Observational studies that reported PSS outcomes. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for abstracting data, and the Joanna Briggs Institute tool was used for risk-of-bias assessment. Data were reported as odds ratio (OR) and standardized mean difference (SMD) with a 95% CI using a random-effects meta-analysis. Publication bias was assessed using funnel plots and the Egger test. Outlier and meta-regression analyses were performed to explore the source of heterogeneity. Data were analyzed from November 2022 to January 2023. Main Outcomes and Measures Measured outcomes were mortality, poor functional outcome (modified Rankin scale [mRS] score 3-6), disability (mean mRS score), recurrent stroke, and dementia at patient follow-up. Results The search yielded 71 eligible articles, including 20 110 patients with PSS and 1 166 085 patients without PSS. Of the participants with PSS, 1967 (9.8%) had early seizures, and 10 605 (52.7%) had late seizures. The risk of bias was high in 5 studies (7.0%), moderate in 35 (49.3%), and low in 31 (43.7%). PSSs were associated with mortality risk (OR, 2.1; 95% CI, 1.8-2.4), poor functional outcome (OR, 2.2; 95% CI, 1.8-2.8), greater disability (SMD, 0.6; 95% CI, 0.4-0.7), and increased dementia risk (OR, 3.1; 95% CI, 1.3-7.7) compared with patients without PSS. In subgroup analyses, early seizures but not late seizures were associated with mortality (OR, 2.4; 95% CI, 1.9-2.9 vs OR, 1.2; 95% CI, 0.8-2.0) and both ischemic and hemorrhagic stroke subtypes were associated with mortality (OR, 2.2; 95% CI, 1.8-2.7 vs OR, 1.4; 95% CI, 1.0-1.8). In addition, early and late seizures (OR, 2.4; 95% CI, 1.6-3.4 vs OR, 2.7; 95% CI, 1.8-4.1) and stroke subtypes were associated with poor outcomes (OR, 2.6; 95% CI, 1.9-3.7 vs OR, 1.9; 95% CI, 1.0-3.6). Conclusions and Relevance Results of this systematic review and meta-analysis suggest that PSSs were associated with significantly increased mortality and severe disability in patients with history of stroke. Unraveling these associations is a high clinical and research priority. Trials of interventions to prevent seizures may be warranted.
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Affiliation(s)
- Shubham Misra
- Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yize Zhao
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Hitten P. Zaveri
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Ece Eldem
- Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Juan Vazquez
- Albert Einstein College of Medicine, Bronx, New York
| | - Lucas Scárdua Silva
- Department of Neurology, School of Medical Sciences, University of Campinas-UNICAMP, Sao Paulo, Brazil
| | - Saba Mohidat
- The University of Melbourne, Melbourne, Victoria, Australia
| | - L. Brian Hickman
- Department of Neurology, The University of California, Los Angeles
| | - Erum I. Khan
- Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
- Alzheimer’s Disease Research Center, University of Alabama, Birmingham
| | - Melissa C. Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - John-Paul Nicolo
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | | | - Clarissa Lin Yasuda
- Department of Neurology, School of Medical Sciences, University of Campinas-UNICAMP, Sao Paulo, Brazil
| | | | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Joseph S. Ross
- Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Patrick Kwan
- The AIM for Health, Faculty of IT, Monash University, Melbourne, Victoria, Australia
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Jerome Engel
- Department of Neurology, The University of California, Los Angeles
| | - Nishant K. Mishra
- Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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4
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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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5
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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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6
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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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7
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Wang WJ, Devine B, Bansal A, White HS, Basu A. Meta-analyzing count events over varying durations using the piecewise Poisson model: The case for poststroke seizures. Res Synth Methods 2020; 12:347-356. [PMID: 33131152 DOI: 10.1002/jrsm.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022]
Abstract
Meta-analyzing count data can be challenging when follow-up time varies across studies. Simply pooling aggregate data over time-periods would result in biased estimates, which may erroneously inform clinical decision-making. In this study, we exploit the convolution property of the Poisson distribution to develop a likelihood for observed cumulative counts over varying follow-up periods, where different Poisson distributions are used to represent the data generating processes for the latent counts in pre-defined successive intervals of follow-up. We illustrate this approach using an example of poststroke seizures, a case in which risk may change over time, and mimic its survival duration with time-varying hazard. Data were extracted from observational studies (1997-2016) reporting poststroke seizures over a maximum of 10 years of follow-up. Three clinically meaningful follow-up time intervals were considered: 0 to 7 days, 8 to 365 days, and 1 to 10 years poststroke. External validation was performed using claims data. Results suggest the incidence rate of seizures was 0.0452 (95% confidence interval: 0.0429, 0.0475), 0.0001 (0, 0.016), and 0.0647 (0.0441, 0.0941) for the three time intervals, respectively, indicating that the risk of seizures changes over time poststroke. We found that the model performed well against the incidence rate of seizures among actual retrospective cohort from claims data. The piecewise Poisson model presents a flexible way to meta-analyze count data over time and mimic survival curves. The results of the piecewise Poisson model are readily interpretable and may spur meaningful clinical action. The method may also be applied to other diseases. HIGHLIGHTS: It is challenging to perform a meta-analysis when follow-up time varies across studies. Ideally, outcomes over different time-periods should be pooled with individual patient-level data (IPD). A new model was developed to meta-analyze count data over time using aggregate-level data from previous published studies. The piecewise Poisson model could be a useful tool to estimate time-vary hazards given available data, and mimic survival curves over time which would be readily interpretable.
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Affiliation(s)
- Wei-Jhih Wang
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA.,Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Aasthaa Bansal
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA.,Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
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8
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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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9
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Eriksson H, Löwhagen Hendén P, Rentzos A, Pujol-Calderón F, Karlsson JE, Höglund K, Blennow K, Zetterberg H, Rosengren L, Zelano J. Acute symptomatic seizures and epilepsy after mechanical thrombectomy. Epilepsy Behav 2020; 104:106520. [PMID: 31526644 DOI: 10.1016/j.yebeh.2019.106520] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to assess the incidence of acute symptomatic seizures and poststroke epilepsy (PSE) in a well-characterized cohort of patients treated with mechanical thrombectomy. In addition, we aimed to describe the dynamics of blood markers of brain injury in patients that developed PSE. METHODS Participants of the prospective AnStroke Trial of anesthesia method during mechanical thrombectomy were included and acute symptomatic seizures and PSE ascertained by medical records review. Blood markers neurofilament light (NFL), tau, glial fibrillary acidic protein (GFAP), S100 calcium-binding protein B (S100B), and neuron-specific enolase (NSE) were assessed. RESULTS A total of 90 patients with acute anterior ischemic stroke were included. Median National Institutes of Health Stroke Scale (NIHSS) at admission to hospital was 18 (IQR 15-22). Recanalization was achieved in 90%. No patients had epilepsy prior to the ischemic stroke. Four patients (4.4%) had acute symptomatic seizures and four patients (4.4%) developed PSE during the follow-up time (to death or last medical records review) of 0-4.5 years (median follow-up 1070 days IQR 777-1306), resulting in a two-year estimated PSE risk of 5.3% (95%CI: 0.2-10.4%). Blood markers of brain injury (NFL, tau, GFAP, S100B, and NSE) were generally above the cohort median in patients that developed PSE. CONCLUSIONS The incidence of PSE after mechanical thrombectomy was low in our cohort. All blood biomarkers displayed interesting sensitivity and specificity. However, the number of PSE cases was small and more studies are needed on risk factors for PSE after mechanical thrombectomy. The potential of blood markers of brain injury markers to contribute to assessment of PSE risk should be explored further. This article is part of the Special Issue "Seizures & Stroke".
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Affiliation(s)
- Hanna Eriksson
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden
| | - Pia Löwhagen Hendén
- Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden.; Department of Anesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Alexandros Rentzos
- Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden.; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Fani Pujol-Calderón
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Jan-Erik Karlsson
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden
| | - Kina Höglund
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Kaj Blennow
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at UCL, London, United Kingdom; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Lars Rosengren
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden
| | - Johan Zelano
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Blå stråket 7, 413 46, Sweden..
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10
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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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11
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Leo A, De Caro C, Nesci V, Tallarico M, De Sarro G, Russo E, Citraro R. Modeling poststroke epilepsy and preclinical development of drugs for poststroke epilepsy. Epilepsy Behav 2020; 104:106472. [PMID: 31427267 DOI: 10.1016/j.yebeh.2019.106472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022]
Abstract
Stroke is a severe clinical issue for global public health, representing the third leading cause of death and a major cause of disability in developed countries. Progresses in the pharmacological treatment of the acute stroke have given rise to a significant decrease in its mortality rate. However, as a result, there has been an increasing number of stroke survivors living with disability worldwide. Poststroke epilepsy (PSE) is a common clinical complication following stroke. Seizures can arise in close temporal association with stroke damage and/or after a variably longer interval. Overall, PSE have a good prognosis; in fact, its responding rate to antiepileptic drugs (AEDs) is higher than other types of epilepsy. However, regarding pharmacological treatment, some issues are still unresolved. To this aim, a deeper understanding of mechanisms underlying the transformation of infarcted tissue into an epileptic focus or better from a nonepileptic brain to an epileptic brain is also mandatory for PSE. However, studying epileptogenesis in patients with PSE clearly has several limitations and difficulties; therefore, modeling PSE is crucial. Until now, different experimental models have been used to study the etiopathology of cerebrovascular stroke with or without infarction, but few studies focused on poststroke epileptogenesis and PSE. In this review, we show a brief overview on the features emerging from preclinical research into experimental PSE, which could affect the discovery of biomarkers and therapy strategies for poststroke epileptogenesis. This article is part of the Special Issue "Seizures & Stroke".
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Affiliation(s)
- Antonio Leo
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa e Germaneto, 88100 Catanzaro, Italy
| | - Carmen De Caro
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa e Germaneto, 88100 Catanzaro, Italy
| | - Valentina Nesci
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa e Germaneto, 88100 Catanzaro, Italy
| | - Martina Tallarico
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa e Germaneto, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa e Germaneto, 88100 Catanzaro, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa e Germaneto, 88100 Catanzaro, Italy.
| | - Rita Citraro
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa e Germaneto, 88100 Catanzaro, Italy
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12
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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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13
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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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14
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The Association Between Atrial Fibrillation and Poststroke Seizures is Influenced by Ethnicity and Environmental Factors. J Stroke Cerebrovasc Dis 2018; 27:2755-2760. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/28/2018] [Indexed: 12/31/2022] Open
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15
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Nesselroth D, Gilad R, Namneh M, Avishay S, Eilam A. Estimation of seizures prevalence in ischemic strokes after thrombolytic therapy. Seizure 2018; 62:91-94. [PMID: 30312935 DOI: 10.1016/j.seizure.2018.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Post stroke seizures are a complication that occur in 5-20% of acute ischemic stroke (AIS) patients, cause a reduction in quality of life and a greater burden on the health system. There is not enough data regarding an association between today's standard of care treatment in AIS: recombinant tissue plasminogen activator (r-tPA) and the risk for post stroke seizures. Our aim in this work is to reveal such a connection. METHOD A non-randomized retrospective cohort-controlled study of 234 patients, who were hospitalized with acute ischemic stroke at Kaplan Medical Center in the years 2009-2015 and were divided into two different treatment groups: r-tPA and antiaggregant therapy(n = 141) and antiaggregant therapy only (n = 95) was conducted by us. Information regarding demographics, medical history, nature of the event, including NIHSS values on admission, discharge, and post stroke seizures, were obtained for each group. Follow-up was done for one year. RESULTS During the year of follow-up, 19 patients (8.1%) of the overall cohort, developed seizures: 12 of them (12.6%) belonged to the control group and 7 (5%) to the study group p < 0.05). Results showed a decrease in the risk for developing seizure when treated with r-tpA, comparing to antiaggregants (odds ratio = 0.64). CONCLUSION This study suggests there is an association between r-tPA treatment and reduction of the risk for post stroke seizures.
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Affiliation(s)
| | - Ronit Gilad
- Neurological department, Kaplan Medical Center, Rechovot, Israel; Hebrew university, Jerusalem, Israel
| | - Montaser Namneh
- Neurological department, Kaplan Medical Center, Rechovot, Israel
| | - Sarit Avishay
- Management department, Kaplan Medical Center, Rechovot, Israel
| | - Anda Eilam
- Neurological department, Kaplan Medical Center, Rechovot, Israel.
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16
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Outcome and predictive factors in post-stroke seizures: A retrospective case-control study. Seizure 2018; 62:11-16. [PMID: 30245457 DOI: 10.1016/j.seizure.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate clinical, radiographic, and electrophysiological features in the development and prognosis of ischemic post-stroke seizures (PSS). METHOD A retrospective study of 1119 patient records was performed between January 2006 and December 2016. After selection, 42 patients with seizures due to ischemic stroke were matched to a control group of 60 patients where seizures were absent. Stroke size and severity were analyzed using ASPECTS and NIHSS, respectively. Hemorrhagic transformation graded by ECASS III classification. Outcomes were assessed using the modified Rankin Scale. Fisher's exact test assessed categorical variables, and Mann-Whitney tested continuous variables. RESULTS Forty-two patients experienced PSS (22 females; median age 72.5 years) and were matched with 60 control subjects that had ischemic stroke without seizures. Focal seizures were present in 42.9% (18/42), and focal to bilateral convulsions in 57.1% (24/42). Stroke localization and severity did not differ (p = 0.6 and 0.21, respectively). Stroke size in anterior circulation was larger in PSS patients (median ASPECTS 6 vs 8 [p = 0.01]). Posterior circulation stroke size was similar in both groups. The presence of hemorrhage was the primary risk factor for PSS (61.9%) compared to controls (36.7%), p = 0.01. The presence of laminar necrosis (LN) (47.6% vs 21.6%, p = 0.005) and hemosiderin deposition (38.1% vs 18.3%, p = 0.02) were most predictive. PSS patients demonstrated worse outcomes than the controls (median mRS 3 vs 2, [p=<0.001]) with a median follow up of 14.8 and 20.7 months, respectively. CONCLUSIONS The size of anterior infarction, presence of blood products within the infarct bed, and especially LN predicted PSS.
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17
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Singh RJ, Chen S, Ganesh A, Hill MD. Long-term neurological, vascular, and mortality outcomes after stroke. Int J Stroke 2018; 13:787-796. [DOI: 10.1177/1747493018798526] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Despite improved survival and short-term (90-day) outcomes of ischemic stroke patients, only sparse data exist describing the sustained benefits of acute stroke care interventions and long-term prognosis of stroke survivors. Aim We review the contemporary literature assessing long-term (5 years or more) outcomes after stroke and acute stroke treatment. Summary of review Acute stroke unit care and intravenous thrombolysis have sustained benefits over longer follow-up, but few data exist on the long-term outcome after endovascular thrombectomy (EVT). A large proportion of stroke survivors face challenges of residual disability and neuropsychiatric sequelae (especially affective disorders and epilepsy) which affects their quality of life and is associated with poorer prognosis due to increase in stroke recurrences/mortality. Nearly, a quarter of stroke survivors have a recurrent stroke at 5 years, and nearly double that at 10 years. Mortality after recurrent stroke is high, and half of the stroke survivors are deceased at 5 years after stroke and three fourth at 10 years. Long-term all-cause mortality is largely due to conditions other than stroke. Both stroke recurrence and long-term mortality are affected by several modifiable risk factors, and thus amenable to secondary prevention strategies. Conclusions There is a need for studies reporting longer term effects of acute interventions, especially EVT. Better preventive strategies are warranted to reduce the vascular and non-vascular mortality long after stroke.
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Affiliation(s)
- Ravinder-Jeet Singh
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Shuo Chen
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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18
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Chi NF, Kuan YC, Huang YH, Chan L, Hu CJ, Liu HY, Chiou HY, Chien LN. Development and validation of risk score to estimate 1-year late poststroke epilepsy risk in ischemic stroke patients. Clin Epidemiol 2018; 10:1001-1011. [PMID: 30174459 PMCID: PMC6110266 DOI: 10.2147/clep.s168169] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective This study aimed to develop and validate a prognostic model for the 1-year risk of late poststroke epilepsy (PSE). Materials and methods We included patients initially diagnosed with ischemic stroke between 2003 and 2014 in a National Health Insurance claims-based cohort in Taiwan. Patients were further divided into development and validation cohorts based on their year of stroke diagnosis. Multivariable Cox regression with backward elimination was used to analyze the association between 1-year PSE and risk factors before and on stroke admission. Results In total, 1,684 (1.93%) and 725 (1.87%) ischemic stroke patients comprising the development and validation cohorts, respectively, experienced late PSE within 1 year after stroke. Seven clinical variables were examined to be independently associated with 1-year risk of PSE. We developed a risk score called "PSEiCARe" ranging from 0 to 16 points, comprising the following factors: prolonged hospital stay (>2 weeks, 1 point), seizure on admission (6 points), elderly patients (age ≥80 years, 1 point), intensive care unit stay on admission (3 points), cognitive impairment (dementia, 2 points), atrial fibrillation (2 points), and respiratory tract infection (pneumonia) on admission (1 point). Patients were further classified into low-, medium-, high-, and very-high-risk groups. The incidence (per 100 person-years) was 0.64 (95% CI: 0.56-0.71) for the low-risk, 2.62 (95% CI: 2.43-2.82) for the medium-risk, 10.3 (95% CI: 9.48-11.3) for the high-risk, and 28.2 (95% CI: 24.0-33.0) for the very-high-risk groups. Discrimination and calibration were satisfactory, with a Harrell's C of 0.762 in the development model and 0.792 in the validation model. Conclusion PSEiCARe is an easy-to-use prognostic score that integrates patient characteristics and clinical factors on stroke admission to predict 1-year PSE risk; it has the potential to assist individualized patient management and improve clinical practice, thereby preventing the occurrence of late PSE.
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Affiliation(s)
- Nai-Fang Chi
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Yi-Chun Kuan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Yao-Hsien Huang
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Lung Chan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Chaur-Jong Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China.,PhD Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, College of Public Health, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan, Republic of China,
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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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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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Shiue I. Risks of atrial fibrillation and death at discharge after thrombolysis in stroke patients: Northumbrian Sentinel Stroke Audit, 2013-2015. Acta Neurol Scand 2017; 135:257-262. [PMID: 27072413 DOI: 10.1111/ane.12603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to examine risks of atrial fibrillation and death at discharge in stroke patients treated with thrombolysis in a subregional setting covering full calendar years with a clear study catchment drawn serving as a confirmatory statistical analysis from the northeast of England in the last 2 years. METHODS Data between 16 June, 2013 and 15 June, 2015 were extracted from Sentinel Stroke National Audit Programme in Northumbria Healthcare NHS Foundation Trust that has covered health service for Northumberland and North Tyneside. RESULTS The very old people aged 80 and above were less likely to have thrombolysis treatment, while there was no sex difference observed. Moreover, thrombolysis treatment was more likely to be given in ischemic patients with severe stroke symptoms. There was no difference in comorbidities including atrial fibrillation, congestive heart failure, diabetes, hypertension, and stroke/TIA as well. Those who received thrombolysis treatment were more likely to have atrial fibrillation or die at discharge. The ORs were higher after additionally adjusting for comorbidities. Similarly, these patients also had poorer scoring in modified Rankin scale than those who did not receive thrombolysis treatment. However, there was no difference at 6 months after survival. CONCLUSION For future research, clinical outcomes in addition to atrial fibrillation and quality of life both at discharge and 6 months after thrombolysis treatment should be included for examination as well. For clinical practice, giving thrombolysis treatment in hospitals might need to be reconsidered if clinical outcomes were actually worse than not.
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Affiliation(s)
- I. Shiue
- Faculty of Health and Life Sciences; Northumbria University; Newcastle upon Tyne UK
- Northumbria Healthcare NHS Foundation Trust; Newcastle upon Tyne UK
- Alzheimer Scotland Dementia Research Centre; University of Edinburgh; Edinburgh UK
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Leung T, Leung H, Soo YOY, Mok VCT, Wong KS. The prognosis of acute symptomatic seizures after ischaemic stroke. J Neurol Neurosurg Psychiatry 2017; 88:86-94. [PMID: 26818728 DOI: 10.1136/jnnp-2015-311849] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/07/2015] [Accepted: 11/26/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Acute symptomatic seizure (AS) after ischaemic stroke is defined as a seizure occurring ≤7 days of the stroke. There remains a lack of information on the prognosis of AS after ischaemic stroke and how it should be treated. METHODS We prospectively recruited patients after their incidents of ischaemic stroke from a population-based stroke registry. Stroke aetiology was defined according to Trial-of-ORG-10172 in acute-stroke treatment (TOAST). Patients were examined for any transient complete-occlusion with recanalisation (TCOR) and haemorrhagic transformation. The seizure outcomes were (1) acute clustering of seizures ≤7 days, (2) seizure recurrence associated with stroke recurrence beyond the 7-day period and (3) unprovoked seizure (US) >7 days. RESULTS 104 patients (mean age 65 years/55% female) with AS after ischaemic stroke were identified (mean follow-up 6.17 years). Comparison of the group of patients with AS and those without seizures showed that patients with AS had significantly less large-vessel and small-vessel disease but more cardioembolisms (p<0.05) and a higher proportion of TCOR (p<0.01), multiple territory infarcts (p=0.007) and haemorrhagic transformations (p<0.01). Using Kaplan-Meier statistics, the risk of acute clustering of seizures ≤7 days was 22%, with a statistical trend for TCOR as a predictive factor (p=0.06). The risk of seizure recurrence associated with worsening/recurrence of stroke beyond 7 days was 13.5% at 2 years, 16.4% at 4 years and 18% at 8 years. Presence of >2 cardiovascular risk factors (p<0.05) and status epilepticus (P<0.05) are predictive risk factors on Cox regression model. The risk of US was 19% at 2 years, 25% at 4 years and 28% at 8 years with epileptiform EEG as a predictive factor (p<0.05). CONCLUSIONS Seizure recurrence following AS after ischaemic stroke may appear as acute clustering. Afterwards, seizures may occur as often with a recurrent stroke as without one within 4.2 years. We recommend the use of antiepileptic agents for up to 4 years if the underlying stroke aetiology cannot be fully treated.
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Affiliation(s)
- Thomas Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Howan Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yannie O Y Soo
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - K S Wong
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Xu T, Ou S, Liu X, Yu X, Yuan J, Huang H, Chen Y. Association between seizures after ischemic stroke and stroke outcome: A systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4117. [PMID: 27399117 PMCID: PMC5058846 DOI: 10.1097/md.0000000000004117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A systematic review and meta-analysis were performed to investigate a potential association between post-ischemic stroke seizures (PISS) and subsequent ischemic stroke (IS) outcome.A systematic search of two electronic databases (Medline and Embase) was conducted to identify studies that explored an association between PISS and IS outcome. The primary and secondary IS outcomes of interest were mortality and disability, respectively, with the latter defined as a score of 3 to 5 on the modified Rankin Scale.A total of 15 studies that were published between 1998 and 2015 with 926,492 participants were examined. The overall mortality rates for the patients with and without PISS were 34% (95% confidence interval [CI], 27-42%) and 18% (95% CI, 12-23%), respectively. The pooled relative ratio (RR) of mortality for the patients with PISS was 1.97 (95% CI, 1.48-2.61; I = 88.6%). The overall prevalence rates of disability in the patients with and without PISS were 60% (95% CI, 32-87%) and 41% (95% CI, 25-57%), respectively. Finally, the pooled RR of disability for the patients with PISS was 1.64 (95% CI, 1.32-2.02; I = 66.1%).PISS are significantly associated with higher risks of both mortality and disability. PISS indicate poorer prognoses in patients experiencing IS.
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Affiliation(s)
| | | | | | | | | | | | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Yangmei Chen, Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, 400010, China (e-mail: )
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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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Zou S, Wu X, Zhu B, Yu J, Yang B, Shi J. The pooled incidence of post-stroke seizure in 102 008 patients. Top Stroke Rehabil 2015; 22:460-7. [PMID: 25920619 DOI: 10.1179/1074935715z.00000000062] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Post-stroke seizures and epilepsy may worsen the recovery and increase the disability of stroke patients during their daily lives. However, few meta-analysis studies have been conducted on post-stroke seizures incidence. We carried on a meta-analysis on the incidence rate of post-stroke seizures and associated factors. METHODS We searched the Medline, Embase, Web of Science, Science Citation Index, and Cochrane Library electronic databases (1990-2013) to identify observational studies of post-stroke seizures. Two authors independently extracted the related information from all included studies. We calculated the pooled incidence by meta-analysis using the software R version 12.3. RESULTS A total of 34 longitudinal cohort studies involving 102 008 patients were included in our meta-analysis. The pooled incidence rate of post-stroke seizures was found to be 0.07 [95% confidence interval (CI), 0.05-0.09] while the rate of post-stroke epilepsy (PSE) was 0.05 (95% CI, 0.04-0.06). The incidence of post-stroke seizures in hemorrhagic stroke (0.10, 0.08-0.13) was much higher than in ischemic stroke (0.06, 0.04-0.08) and when the cortical region was involved (0.15, 0.10-0.21). CONCLUSIONS Our meta-analysis showed that seizures occurred in about 6.93% of people with stroke. Seizures occurred more commonly after hemorrhagic stroke and when stroke occurred in the cortical region.
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Affiliation(s)
- Safeng Zou
- Department of Rehabilitation, Dalian Municipal Central Hospital , Dalian, China
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