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Huang YC, Wong YS, Wu CS, Tsai CF, Ong CT. Modified CAVE score for predicting late seizures after intracerebral hemorrhage. BMC Neurol 2023; 23:448. [PMID: 38114955 PMCID: PMC10729474 DOI: 10.1186/s12883-023-03510-1] [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: 10/23/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND PURPOSE Seizures commonly occur in patients with intracerebral hemorrhage (ICH). Anticonvulsants are commonly used for preventing seizures in patients with ICH. Thus, patients with ICH at high risk of seizures must be identified. The study aims to elucidate whether double the score of cortex involvement in ICH patients can increase accuracy of CAVE score for predicting late seizures. METHOD This retrospective analysis of the medical records of surviving patients admitted between June 1, 2013, and December 31, 2019. Validated the CAVE score and modified it (CAVE2). The main outcome of patients with ICH was seizures. The first seizures occurring within 7 days after a stroke were defined as early seizures. Seizures occurring after 1 week of stroke onset, including patients who had experienced early seizures or patients who had not, were defined as late seizures. CAVE and CAVE2 scores were validated using the cohort. The accuracy and discrimination of those two scores were accessed by the area under the operating characteristic curve. Akaike information criterion, integrated discrimination improvement, and continuous net reclassification improvement were used to assess the performance of the CAVE and CAVE2 scores. RESULTS In the cohort showed that late seizures occurred in 12.7% (52/408) of patients with ICH. Male sex, age > 65 years, cortex involvement, and early seizures were associated with the occurrence of late seizures, with odds ratios of 2.09, 2.04, 4.12, and 3.78, respectively. The risk rate of late seizures was 6.66% (17/255), 14.8% (17/115), and 47.4% (18/38) for CAVE scores ≤ 1, 2, and ≥ 3, and 4.6% (12/258), 18.3% (13/71), and 54.4 (20/37) for CAVE2 scores ≤ 1, 2, and ≥ 3 respectively. The C-statistics for the CAVE and CAVE2 scores were 0.73 and 0.74 respectively. CONCLUSION The CAVE score can identify patients with ICH and high risk for late seizures. The CAVE can be modified by changing the score of cortex involvement to 2 points to improve accuracy in predicting late seizures in patients with ICH.
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Affiliation(s)
- Yu-Ching Huang
- Department of Neurology, Tao-yuan General Hospital, Ministry of Healthy and Welfare, Tao-yuan, Taiwan
- Department of Industrial Engineering and Management, Yuan-Ze University, Tao-yuan, Taiwan
| | - Yi-Sin Wong
- Department of Family Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Chi-Shun Wu
- Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Chung-Shao Road, Chia-Yi, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Cheung-Ter Ong
- Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Chung-Shao Road, Chia-Yi, Taiwan.
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Nandan A, Zhou YM, Demoe L, Waheed A, Jain P, Widjaja E. Incidence and risk factors of post-stroke seizures and epilepsy: systematic review and meta-analysis. J Int Med Res 2023; 51:3000605231213231. [PMID: 38008901 PMCID: PMC10683575 DOI: 10.1177/03000605231213231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Due to variability in reports, the aim of this meta-analysis was to evaluate the incidence and risk factors of post-stroke early seizures (ES) and post-stroke epilepsy (PSE). METHODS The MEDLINE, EMBASE and Web of Science databases were searched for post-stroke ES/PSE articles published on any date up to November 2020. Post-stroke ES included seizures occurring within 7 days of stroke, and PSE included at least one unprovoked seizure. Using random effects models, the incidence and risk factors of post-stroke ES and PSE were evaluated. The study was retrospectively registered with INPLASY (INPLASY2023100008). RESULTS Of 128 included studies in total, the incidence of post-stroke ES was 0.07 (95% confidence interval [CI] 0.05, 0.10) and PSE was 0.10 (95% CI 0.08, 0.13). The rates were higher in children than adults. Risk factors for post-stroke ES included hemorrhagic stroke (odds ratio [OR] 2.14, 95% CI 1.44, 3.18), severe strokes (OR 2.68, 95% CI 1.73, 4.14), cortical involvement (OR 3.09, 95% CI 2.11, 4.51) and hemorrhagic transformation (OR 2.70, 95% CI 1.58, 4.60). Risk factors for PSE included severe strokes (OR 4.92, 95% CI 3.43, 7.06), cortical involvement (OR 3.20, 95% CI 2.13, 4.81), anterior circulation infarcts (OR 3.28, 95% CI 1.34, 8.03), hemorrhagic transformation (OR 2.81, 95% CI 1.25, 6.30) and post-stroke ES (OR 7.24, 95% CI 3.73, 14.06). CONCLUSION Understanding the risk factors of post-stroke ES/PSE may identify high-risk individuals who might benefit from prophylactic treatment.
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Affiliation(s)
- Aathmika Nandan
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Yi Mei Zhou
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Lindsay Demoe
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
| | - Adnan Waheed
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Puneet Jain
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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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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Lin HY, Wei QQ, Huang JY, Pan XH, Liang NC, Huang CX, Long T, Gao W, Shi SL. Relationship Between Mortality and Seizures After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:922677. [PMID: 35795802 PMCID: PMC9251061 DOI: 10.3389/fneur.2022.922677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background The relationship between mortality and seizures after intracerebral hemorrhage (ICH) has not yet been understood until now. A meta-analysis was performed to assess the effect of post-ICH seizures on mortality among patients with ICH. Methods PubMed and Embase were searched from the establishment of the databases to December 2021 to identify literature that evaluated the relationship between post-ICH seizures and mortality in ICH. Crude odds ratios and adjusted odds ratios with a 95% confidence interval (CI) were pooled using a random-effects model. Results Thirteen studies involving 245,908 participants were eventually included for analysis. The pooled estimate suggested that post-ICH seizures were not associated with significantly increased mortality in patients with ICH (crude odds ratios 1.35, 95% CI: 0.91–2; adjusted adds ratios 1.22, 95% CI: 0.78–1.88). However, the relationship was not consistent in subgroup analysis or robust in a sensitivity analysis. Conclusions This meta-analysis proved that post-ICH seizures were not associated with significantly increased mortality in patients with ICH. However, this result could be influenced by confounding factors, so more high-quality research is needed.
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Affiliation(s)
- Hong-yu Lin
- Department of Neurology, People's Hospital of Chongzuo City, Chongzuo, China
| | - Qing-qing Wei
- Department of Neurology, People's Hospital of Chongzuo City, Chongzuo, China
| | - Jian-yi Huang
- Department of Neurology, People's Hospital of Chongzuo City, Chongzuo, China
| | - Xing-hua Pan
- Department of Neurology, People's Hospital of Chongzuo City, Chongzuo, China
| | - Ning-chao Liang
- Department of Neurology, People's Hospital of Chongzuo City, Chongzuo, China
| | - Cai-xia Huang
- Department of Neurology, People's Hospital of Chongzuo City, Chongzuo, China
- *Correspondence: Cai-xia Huang
| | - Teng Long
- Department of Neurology, People's Hospital of Chongzuo City, Chongzuo, China
| | - Wen Gao
- Department of Neurology, People's Hospital of Liuzhou City, Liuzhou, China
| | - Sheng-liang Shi
- Department of Neurology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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5
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Guo X, Zhong R, Han Y, Zhang H, Zhang X, Lin W. Incidence and relevant factors for seizures after spontaneous intracerebral hemorrhage: A systematic review and meta-analysis. Seizure 2022; 101:30-38. [DOI: 10.1016/j.seizure.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/01/2022] Open
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Wong YS, Wu CS, Ong CT. Discontinuation of preventive antiepileptic drugs in patients with intracerebral hemorrhage. BMC Neurol 2021; 21:150. [PMID: 33827479 PMCID: PMC8025523 DOI: 10.1186/s12883-021-02177-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background The risk factors for seizures in patients with intracerebral hemorrhage (ICH) stroke and the effect of seizure prevention by anticonvulsant are not well understood. Limited studies have investigated the risk of seizure after discontinuing antiepileptic drugs in patients with ICH. This study aimed to investigate the role of valproic acid (VA) for seizure prevention and to access the risk of seizure after anticonvulsant withdrawal in patients with spontaneous ICH. Methods Between 2013 and 2015, 177 patients with ICH were enrolled in this 3-year retrospective study. Seizures were classified as early seizure (first seizure within 1 week of ICH), delayed seizure (first seizure after 1 week), and late seizure (any seizure after 1 week). Binary logistic regression was used to evaluate the relationship between baseline clinical factors and late seizures between study periods. VA was prescribed or discontinued based on the decision of the physician in charge. Results Seizures occurred in 24 patients, including early seizure in 6.78% (12/177) of the patients, delayed seizure in 7.27% (12/165) of the patients without early seizure, and late seizure in 9.60% (17/177) of the patients. Most seizures occurred within the first year. Binary logistic regression analysis showed ICH with cortex involvement as the independent risk factor for seizures. VA did not decrease the risk of seizures. Patients with ICH with cortical involvement using anticonvulsants for longer than 3 months did not have a decreased risk of seizures (odds ratio 1.86, 95% CI: 0.43–8.05). Conclusions Spontaneous ICH with cortex involvement is the risk factor for seizure. Most seizures occurred within 1 year after stroke onset over a 3-year follow up. Discontinuation of antiepileptic drug within 3 months in patients does not increase the risk of seizure. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02177-w.
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Affiliation(s)
- Yi-Sin Wong
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.,Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chi-Shun Wu
- Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Chung-Shao Road, Chia-Yi, Taiwan
| | - Cheung-Ter Ong
- Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Chung-Shao Road, Chia-Yi, Taiwan.
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7
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Chen Z, Mo J, Xu J, Qin H, Zheng H, Pan Y, Meng X, Jing J, Xiang X, Wang Y. Risk Profile of Ischemic Stroke Caused by Small-Artery Occlusion vs. Deep Intracerebral Hemorrhage. Front Neurol 2019; 10:1213. [PMID: 31827458 PMCID: PMC6890715 DOI: 10.3389/fneur.2019.01213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Small-artery occlusion (SAO) subtype accounts for a quarter of the cases of ischemic stroke and is mainly caused by pathological changes in cerebral small vessels, which also involve in deep intracerebral hemorrhage (dICH). However, the factors that drive some cases to SAO and others to dICH remained incompletely defined. Material and Methods: This study is a cross-sectional study from the China National Stroke Registry that included consecutive patients with ischemic stroke or intracerebral hemorrhage between August 2007 and September 2008. We compared the risk profile between the two subgroups using multivariable logistic regression. Results: A total of 1,135 patients with SAO stroke and 1,125 dICH patients were included for analyses. Generally, patients with SAO stroke were more likely to be male (odds ratio = 0.74, confidence interval = 0.58-0.94) and have diabetes (0.30, 0.22-0.40), higher atherogenic lipid profiles, higher body mass index (0.96, 0.94-0.99), higher waist/height ratio (0.12, 0.03-0.48), higher platelet count (0.84, 0.77-0.91), and higher proportion of abnormal estimated glomerular filtration rate (<90, ml/min/1.73 m2) (0.77, 0.62-0.95). Conversely, patients with dICH were more likely to have higher blood pressure parameters, inflammation levels (white blood cell count: 1.61, 1.48-1.76; high sensitivity C-reactive protein: 2.07, 1.36-3.16), and high-density lipoprotein-c (1.57, 1.25-1.98). Conclusions: The risk profile between SAO stroke and dICH were different. Furthermore, despite of traditional indexes, waist/height ratio, platelet count, inflammation levels, lipid profile, and estimated glomerular filtration rate also play important roles in driving arteriolosclerosis into opposite ends.
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Affiliation(s)
- Zimo Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jinglin Mo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xianglong Xiang
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Tørnes M, McLernon DJ, Bachmann MO, Musgrave SD, Warburton EA, Potter JF, Myint PK. Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke. Front Neurol 2019; 10:827. [PMID: 31447761 PMCID: PMC6691802 DOI: 10.3389/fneur.2019.00827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals. Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service (NHS) acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modeled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics. Results: We included 2,241 stroke admissions in our analysis; 171 (7.6%) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3 to 11%. The hospital that had the lowest odds of UTI [odds ratio (OR) = 0.50 (95% confidence interval (CI) 0.22–.11)] in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate [OR=2.69 (1.56–4.64)] was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner. Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to be addressed to improve the ultimate stroke outcome.
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Affiliation(s)
- Michelle Tørnes
- Ageing Clinical and Experimental Research Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - David J McLernon
- Medical Statistics Team, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Max O Bachmann
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Stanley D Musgrave
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | | | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Phyo Kyaw Myint
- Ageing Clinical and Experimental Research Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, United Kingdom
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9
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Zhang W, Wang L, Pang X, Zhang J, Guan Y. Role of microRNA-155 in modifying neuroinflammation and γ-aminobutyric acid transporters in specific central regions after post-ischaemic seizures. J Cell Mol Med 2019; 23:5017-5024. [PMID: 31144434 PMCID: PMC6653087 DOI: 10.1111/jcmm.14358] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/14/2019] [Accepted: 04/14/2019] [Indexed: 12/16/2022] Open
Abstract
In the central nervous system, interleukin (IL)‐1β, IL‐6 and tumour necrosis factor (TNF)‐α have a regulatory role in pathophysiological processes of epilepsy. In addition, γ‐aminobutyric acid (GABA) transporter type 1 and type 3 (GAT‐1 and GAT‐3) modulate the levels of extracellular GABA in involvement in the neuroinflammation on epileptogenesis. Thus, in the current report we examined the effects of inhibiting microRNA‐155 (miR‐155) on the levels of IL‐1β, IL‐6 and TNF‐α, and expression of GAT‐1 and GAT‐3 in the parietal cortex, hippocampus and amygdala of rats with nonconvulsive seizure (NCS) following cerebral ischaemia. Real time RT‐PCR, ELISA and Western blot analysis were used to examine the miR‐155, proinflammatory cytokines (PICs) and GAT‐1/GAT‐3 respectively. With induction of NCS, the levels of miR‐155 were amplified in the parietal cortex, hippocampus and amygdala and this was accompanied with increases of IL‐1β, IL‐6 and TNF‐α. In those central areas, expression of GAT‐1 and GAT‐3 was upregulated; and GABA was reduced in rats following NCS. Intracerebroventricular infusion of miR‐155 inhibitor attenuated the elevation of PICs, amplification of GAT‐1 and GAT‐3 and impairment of GABA. Furthermore, inhibition of miR‐155 decreased the number of NCS events following cerebral ischaemia. Inhibition of miR‐155 further improved post‐ischaemia‐evoked NCS by altering neuroinflammation‐GABA signal pathways in the parietal cortex, hippocampus and amygdala. Results suggest the role of miR‐155 in regulating post‐ischaemic seizures via PICs‐GABA mechanisms.
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Affiliation(s)
- Wenwen Zhang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Luping Wang
- Department of Anesthesiology, School and Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Xiaochuan Pang
- Clinical Laboratory, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jian Zhang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yi Guan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
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Impact of antiepileptic drugs for seizure prophylaxis on short and long-term functional outcomes in patients with acute intracerebral hemorrhage: A meta-analysis and systematic review. Seizure 2019; 69:140-146. [PMID: 31048270 DOI: 10.1016/j.seizure.2019.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this analysis is to assess the effect of antiepileptics (AEDs) on seizure prevention and short and long term functional outcomes in patients with acute intracerebral hemorrhage. METHOD The meta-analysis was conducted using the PRISMA guidelines. A literature search was performed of the PubMed, the Cochrane Library, and EMBASE databases. Search terms included "Anticonvulsants", "Intracerebral Hemorrhage", and related subject headings. Articles were screened and included if they were full-text and in English. Articles that did not perform multivariate regression were not included. Overall effect size was evaluated with forest plots and publication bias was assessed with the Begg's and Egger's tests. RESULTS A total of 3912 articles were identified during the initial review. After screening, 54 articles remained for full review and 6 articles were included in the final analysis. No significant association between the use of AEDs after ICH and functional outcome (OR 1.53 [95%CI: 0.81-2.88] P = 0.18, I2 = 81.7%). Only one study evaluated the effect AEDs had in preventing post-ICH seizures. CONCLUSIONS The use of prophylactic AEDs was not associated with improved short and long outcomes after acute ICH. This analysis supports the 2015 AHA/ASA recommendation against prophylactic AEDs (class III; level of evidence b).
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Duan W, Pan Y, Wang C, Wang Y, Zhao X, Wang Y, Liu L. Risk Factors and Clinical Impact of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: Analysis from the China National Stroke Registry. Neuroepidemiology 2018. [PMID: 29529609 DOI: 10.1159/000487325] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) is a significant cause of morbidity and mortality. While it is important to detect early signs of DCI, patients with high risk of DCI are difficult to identify, and the potential risk factors are uncertain. This study aimed to identify independent risk factors of DCI and clarify their clinical impact on outcome and the disease course. METHODS For this nationwide, multicenter, prospective clinical study involving consecutive patients with aSAH recruited from the China National Stroke Registry, demographic, clinical, radiological, and laboratorial data during hospitalisation, in-hospital complications, functional outcomes, and mortality at 3, 6, and 12 months were recorded. Using univariate and multivariate logistic regression to determine risk factors associated with the development of DCI, the contribution of DCI to short- and long-term outcomes was evaluated. RESULTS Of all 504 patients with aSAH, 155 developed DCI. Multivariate analysis revealed that being female, a history of diabetes mellitus, a Hunt and Hess grade of 4-5, and a World Federation of Neurosurgical Societies grade of IV-V were independent risk factors of DCI. DCI was associated with high in-hospital complications, and with a high utilization rate of supporting interventions. DCI also contributed to poorer functional outcome and higher mortality at discharge and after 3, 6, and 12 months. CONCLUSIONS Female sex, a history of diabetes mellitus, and poor clinical grade are independent early risk factors for the development of DCI and can contribute to a better identification of patients at a high risk for DCI. DCI was associated with severe clinical course, poor outcome, and mortality both in the short- and long-term in patients with aSAH in China.
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Affiliation(s)
- Wanying Duan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Chunjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Sun W, Ou Q, Zhang Z, Qu J, Huang Y. Chinese acute ischemic stroke treatment outcome registry (CASTOR): protocol for a prospective registry study on patterns of real-world treatment of acute ischemic stroke in China. Altern Ther Health Med 2017; 17:357. [PMID: 28683732 PMCID: PMC5501552 DOI: 10.1186/s12906-017-1863-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 06/28/2017] [Indexed: 01/02/2023]
Abstract
Rationale Stroke presents a serious health problem in China. Despite progresses made in recent years, there is still a lack of effective treatments for acute ischemic stroke (AIS) in clinical practices. Aims The Chinese Acute Ischemic Stroke Treatment Outcome Registry (CASTOR) is designed to evaluate the patterns and cost-effectiveness of current treatments for AIS in real-world settings in China. Design CASTOR is a prospective, multi-center study registered with ClinicalTrials.gov (NCT02470624) with a target sample size of 10,000 patients who are experiencing AIS. The patients are treated for AIS following the Chinese stroke guideline and local practice. Real-world data on treatment regimens, outcomes and costs are collected at baseline (Visit 1) and during subsequent visits (Visit 2 to Visit 5) after medication treatments. Outcome The primary objective of the present study is to analyze the current treatment status of AIS in real world settings. The secondary objectives include: 1) to compare the effectiveness of common treatment regimens, 2) to analyze the cost-effectiveness of different treatment regimens for AIS, 3) to analyze the incidence of adverse events and complications in enrolled patients with AIS, 4) to analyze the effect of Trial of Org 10,172 in Acute Stroke Treatment (TOAST) classification on the specific therapies during acute phase treatment period. Discussion In face of changing treatment patterns and increasing demand from medical insurers for cost-effectiveness data in China, a large-scale registry study examining the real-world patterns of AIS in hospitals is needed. The CASTOR study will help to find favorable cost-utility treatment regimens for AIS and improve the overall treatment outcome of Chinese patients with AIS. Electronic supplementary material The online version of this article (doi:10.1186/s12906-017-1863-4) contains supplementary material, which is available to authorized users.
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Lahti AM, Saloheimo P, Huhtakangas J, Salminen H, Juvela S, Bode MK, Hillbom M, Tetri S. Poststroke epilepsy in long-term survivors of primary intracerebral hemorrhage. Neurology 2017; 88:2169-2175. [PMID: 28476758 DOI: 10.1212/wnl.0000000000004009] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/20/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To identify the incidence and predisposing factors for development of poststroke epilepsy (PSE) after primary intracerebral hemorrhage (PICH) during a long-term follow-up. METHODS We performed a retrospective study of patients who had had their first-ever PICH between January 1993 and January 2008 in Northern Ostrobothnia, Finland, and who survived for at least 3 months. These patients were followed up for PSE. The associations between PSE occurrence and sex, age, Glasgow Coma Scale (GCS) score on admission, hematoma location and volume, early seizures, and other possible risk factors for PSE were assessed using the Cox proportional hazards regression model. RESULTS Of the 615 PICH patients who survived for longer than 3 months, 83 (13.5%) developed PSE. The risk of new-onset PSE was highest during the first year after PICH with cumulative incidence of 6.8%. In univariable analysis, the risk factors for PSE were early seizures, subcortical hematoma location, larger hematoma volume, hematoma evacuation, and a lower GCS score on admission, whereas patients with infratentorial hematoma location or hypertension were less likely to develop PSE (all variables p < 0.05). In multivariable analysis, we found subcortical location (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.35-3.81, p < 0.01) and early seizures (HR 3.63, 95% CI 1.99-6.64, p < 0.01) to be independent risk factors, but patients with hypertension had a lower risk of PSE (HR 0.54, 0.35-0.84, p < 0.01). CONCLUSIONS Subcortical hematoma location and early seizures increased the risk of PSE after PICH in long-term survivors, while hypertension seemed to reduce the risk.
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Affiliation(s)
- Anna-Maija Lahti
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland.
| | - Pertti Saloheimo
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Juha Huhtakangas
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Henrik Salminen
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Seppo Juvela
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Michaela K Bode
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Matti Hillbom
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Sami Tetri
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland.
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Gilmore EJ, Maciel CB, Hirsch LJ, Sheth KN. Review of the Utility of Prophylactic Anticonvulsant Use in Critically Ill Patients With Intracerebral Hemorrhage. Stroke 2016; 47:2666-72. [PMID: 27608820 DOI: 10.1161/strokeaha.116.012410] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/04/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Emily J Gilmore
- From the Division of Neurocritical Care and Emergency Neurology (E.J.G., C.B.M., K.N.S.), and Division of Epilepsy (L.J.H.); Department of Neurology, Yale-New Haven Hospital, Yale School of Medicine, CT.
| | - Carolina B Maciel
- From the Division of Neurocritical Care and Emergency Neurology (E.J.G., C.B.M., K.N.S.), and Division of Epilepsy (L.J.H.); Department of Neurology, Yale-New Haven Hospital, Yale School of Medicine, CT
| | - Lawrence J Hirsch
- From the Division of Neurocritical Care and Emergency Neurology (E.J.G., C.B.M., K.N.S.), and Division of Epilepsy (L.J.H.); Department of Neurology, Yale-New Haven Hospital, Yale School of Medicine, CT
| | - Kevin N Sheth
- From the Division of Neurocritical Care and Emergency Neurology (E.J.G., C.B.M., K.N.S.), and Division of Epilepsy (L.J.H.); Department of Neurology, Yale-New Haven Hospital, Yale School of Medicine, CT
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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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