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Šmigelskytė A, Gelžinienė G, Jurkevičienė G. Early Epileptic Seizures after Ischemic Stroke: Their Association with Stroke Risk Factors and Stroke Characteristics. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1433. [PMID: 37629723 PMCID: PMC10456278 DOI: 10.3390/medicina59081433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: A growing number of stroke survivors face various stroke complications, including new-onset epileptic seizures (ESs). Post-stroke ESs are divided into early and late ESs based on the time of onset after stroke. Early ESs are associated with worse stroke outcomes, longer hospitalization and an increased risk of late ESs. A variety of risk factors for early ESs are being studied in order to prevent their occurrence. Therefore, we aim to determine the association of early ESs with ischemic stroke risk factors and characteristics. Materials and Methods: A total of 166 patients, treated for ischemic stroke in the Hospital of Lithuanian University of Health Sciences Kaunas Clinics, were enrolled in a prospective cohort study. Initially, data about stroke risk factors, localization, severity and treatment were collected, followed by an observation period of 14 days for early ESs. Results: Early ESs occurred in 11 (6.6%) participants. The probability of early ESs after ischemic stroke among males and females (LogRank = 1.281; p > 0.05), younger (≤65 y) and older (>65 y) participants (LogRank = 0.129; p > 0.05) was the same. The presence of ischemic stroke risk factors, such as atrial fibrillation (LogRank = 0.004; p > 0.05), diabetes mellitus (LogRank = 1.168; p > 0.05) and dyslipidemia (LogRank = 0.092; p > 0.05), did not increase the probability of early ESs. However, participants without a prior history of arterial hypertension (LogRank = 4.453; p < 0.05) were more likely to develop early ESs. Stroke localization (anterior versus posterior) (LogRank = 0.011; p > 0.05), stroke severity (LogRank = 0.395; p > 0.05) and type of treatment (specific versus non-specific) (LogRank = 1.783; p > 0.05) did not affect the probability of early ESs.
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Affiliation(s)
- Agnė Šmigelskytė
- Department of Neurology, Lithuanian University of Health Sciences, A. Mickevičiaus str. 9, LT-44307 Kaunas, Lithuania
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Lasek-Bal A, Dewerenda-Sikora M, Binek Ł, Student S, Łabuz-Roszak B, Krzystanek E, Kaczmarczyk A, Krzan A, Żak A, Cieślik A, Bosak M. Epileptiform activity in the acute phase of stroke predicts the outcomes in patients without seizures. Front Neurol 2023; 14:1096876. [PMID: 36994378 PMCID: PMC10040780 DOI: 10.3389/fneur.2023.1096876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Background and purposeThe abnormalities in EEG of stroke-patients increase the risk of epilepsy but their significancy for poststroke outcome is unclear. This presented study was aimed at determining the prevalence and nature of changes in EEG recordings from the stroke hemisphere and from the contralateral hemisphere. Another objective was to determine the significance of abnormalities in EEG in the first days of stroke for the post-stroke functional status on the acute and chronic phase of disease.MethodsIn all qualified stroke-patients, EEG was performed during the first 3 days of hospitalization and at discharge. The correlation between EEG abnormalities both in the stroke hemisphere and in the collateral hemisphere with the neurological and functional state in various time points was performed.ResultsOne hundred thirty-one patients were enrolled to this study. Fifty-eight patients (44.27%) had abnormal EEG. The sporadic discharges and generalized rhythmic delta activity were the most common abnormalities in the EEG. The neurological status on the first day and the absence of changes in the EEG in the hemisphere without stroke were the independent factors for good neurological state (0–2 mRS) at discharge. The age-based analysis model (OR 0.981 CI 95% 0.959–1.001, p = 0.047), neurological status on day 1 (OR 0.884 CI 95% 0.82–0.942, p < 0.0001) and EEG recording above the healthy hemisphere (OR 0.607 CI 95% 0.37–0.917, p = 0.028) had the highest prognostic value in terms of achieving good status 90 days after stroke.ConclusionsAbnormalities in EEG without clinical manifestation are present in 40% of patients with acute stroke. Changes in EEG in acute stroke are associated with a poor neurological status in the first days and poor functional status in the chronic period of stroke.
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Affiliation(s)
- Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
- *Correspondence: Anetta Lasek-Bal
| | - Milena Dewerenda-Sikora
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Łukasz Binek
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Sebastian Student
- Faculty of Automatic Control Electronics and Computer Science, Silesian University of Technology, Gliwice, Poland
- Biotechnology Center, Silesian University of Technology, Gliwice, Poland
| | - Beata Łabuz-Roszak
- Department of Neurology, Institute of Medical Sciences University of Opole, Opole, Poland
| | - Ewa Krzystanek
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Aleksandra Kaczmarczyk
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Krzan
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Amadeusz Żak
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Aleksandra Cieślik
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University, Katowice, Poland
| | - Magdalena Bosak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Liu F, Chen D, Fu Y, Wang H, Liu L. Incidence and association of seizures in stroke patients following endovascular treatment: A systematic review and meta-analysis. Eur J Neurol 2023; 30:134-143. [PMID: 36094786 DOI: 10.1111/ene.15564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Post-stroke seizures (PSSs) are some of the most common complications of stroke and are associated with poor outcomes in patients. Endovascular treatment (EVT) is the standard of care for patients with acute ischaemic stroke related large-vessel occlusion. However, whether EVT increases the risk of PSSs remains controversial; the association between PSSs and EVT is poorly understood. METHODS PubMed, Embase and the Cochrane Library were searched for relevant studies published from 1995 to 6 December 2021. The overall incidence of PSSs in patients treated with EVT and the separate incidence for all included studies in each subgroup, stratified by the type of treatment or time of onset, were calculated. The pooled odds ratio and confidence interval were calculated to quantify the effects of EVT on PSS occurrence. RESULTS In all, 946 studies were screened and 16 articles were included, with a total sample size of 12,664 patients; 7836 patients received EVT, of whom 460 had PSS. The pooled incidence of PSS after EVT was 5.8%, which was similar to patients treated with mechanical thrombectomy (5.3%), intra-arterial thrombolysis (6.8%) or bridging therapy (5.4%). The cumulative incidence of post-stroke epilepsy (6.0%) was almost twice that of acute symptomatic seizures (3.6%). The pooled odds ratio for the relationship between EVT and PSS was 1.91 (95% confidence interval 0.98-3.73). CONCLUSIONS The cumulative incidence of stroke patients treated with EVT who developed seizures was 5.8%, and EVT was non-significantly associated with the occurrence of seizures after stroke.
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Affiliation(s)
- Fangzhou Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoqi Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Diagnosis and Treatment of Poststroke Epilepsy: Where Do We Stand? Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00744-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Abstract
Purpose of Review
Stroke is the most common cause of seizures and epilepsy in older adults. This educational paper aims to give an update on current clinical aspects of diagnosis and treatment of poststroke epilepsy.
Recent Findings
Regarding epileptic seizures related to stroke, it is important to distinguish between acute symptomatic seizures and unprovoked seizures as they differ in their risk for seizure recurrence. In fact, after a single unprovoked poststroke seizure, a diagnosis of epilepsy can be made because there is a greater than 60% risk for further seizures. Clinical models that can predict the development of epilepsy after a stroke have been successfully established. However, treatment with anti-seizure medications is advised only after a first unprovoked poststroke seizure, as current treatments are not known to be effective for primary prevention. The management of poststroke epilepsy requires consideration of aspects such as age, drug-drug interactions and secondary vascular prophylaxis, yet evidence for the use of anti-seizure medications specifically in poststroke epilepsy is limited.
Summary
This text reviews the epidemiology and risk factors for poststroke epilepsy, explains the role of EEG and neuroimaging in patients with stroke and seizures and provides an overview on the clinical management of stroke-related acute symptomatic seizures and poststroke epilepsy.
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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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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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Chen YH, Sawan M. Trends and Challenges of Wearable Multimodal Technologies for Stroke Risk Prediction. SENSORS (BASEL, SWITZERLAND) 2021; 21:E460. [PMID: 33440697 PMCID: PMC7827415 DOI: 10.3390/s21020460] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
We review in this paper the wearable-based technologies intended for real-time monitoring of stroke-related physiological parameters. These measurements are undertaken to prevent death and disability due to stroke. We compare the various characteristics, such as weight, accessibility, frequency of use, data continuity, and response time of these wearables. It was found that the most user-friendly wearables can have limitations in reporting high-precision prediction outcomes. Therefore, we report also the trend of integrating these wearables into the internet of things (IoT) and combining electronic health records (EHRs) and machine learning (ML) algorithms to establish a stroke risk prediction system. Due to different characteristics, such as accessibility, time, and spatial resolution of various wearable-based technologies, strategies of applying different types of wearables to maximize the efficacy of stroke risk prediction are also reported. In addition, based on the various applications of multimodal electroencephalography-functional near-infrared spectroscopy (EEG-fNIRS) on stroke patients, the perspective of using this technique to improve the prediction performance is elaborated. Expected prediction has to be dynamically delivered with high-precision outcomes. There is a need for stroke risk stratification and management to reduce the resulting social and economic burden.
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Affiliation(s)
- Yun-Hsuan Chen
- CenBRAIN Lab., School of Engineering, Westlake University, Hangzhou 310024, China
- Institute of Advanced Study, Westlake Institute for Advanced Study, Hangzhou 310024, China
| | - Mohamad Sawan
- CenBRAIN Lab., School of Engineering, Westlake University, Hangzhou 310024, China
- Institute of Advanced Study, Westlake Institute for Advanced Study, Hangzhou 310024, China
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