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Lekoubou A, Cohrs A, Dejuk M, Hong J, Sen S, Bonilha L, Chinchilli VM. Acute seizures after spontaneous intracerebral hemorrhage in young individuals: 11-year trends and association with mortality. Epilepsy Res 2024; 205:107408. [PMID: 39002389 DOI: 10.1016/j.eplepsyres.2024.107408] [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: 04/05/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The rate of spontaneous Intracerebral Hemorrhage (sICH) is rising among young Americans. Trends in acute seizure (AS) incidence in this age group is largely unknown. Further, the association of AS with mortality has not been reported in this age group. The aim of this study is to determine trends in AS among young individuals with sICH. METHODS The Merative MarketScan® Commercial Claims and Encounters database, for the years 2005 through 2015, served as the data source for this retrospective in-hospital population study. This period was chosen as spontaneous ICH incidence increased among young individuals between 2005 and 2015. Our study population included patients aged 18-64 years with ICH identified using the International Classification of Diseases, Ninth and Tenth Revision (ICD-9/10) codes 430, 431, 432.0, 432.1, 432.9, I61, I61.0, I61.1, I61.2, I61.3, I61.4, I61.5, I61.6, I61.8, and I61.9, excluding those with a prior diagnosis of seizures (ICD-9/10 codes 345.x,780.3x, G40, G41, and R56.8). We computed yearly AS incidence, mortality (in patients with and without seizures), and analyzed trends. We applied a logistic regression model to determine the independent association of AS with mortality accounting for demographic and clinical variables. RESULTS AS incidence increased linearly between 2005 (incidence rate: 8.1 %) and 2015 (incidence rate: 11.0 %), which represents a 26 % relative increase (P for trends <0.0001). In-hospital mortality rate was 14.3 % among those who developed AS and 11.5 % among those who did not have AS. Overall, between 2005 and 2015, in-hospital mortality decreased from 13.0 % to 9.7 % among patients without AS but remained unchanged among those with AS. Patients who developed AS were 10 % more likely to die than those who did not (OR: 1.10, 95 % confidence interval: 1.02-1.18). CONCLUSIONS Between 2005 and 2015, the incidence of AS increased by nearly 26 % among young Americans with sICH. In-patient mortality remained unchanged among those who developed seizures but declined among those who did not. The occurrence of AS was independently associated with a 10 % higher risk of in-hospital death.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Milton S. Hershey Medical Center, Pennsylvania State University, USA; Department of Public Health Sciences, Pennsylvania State University, USA.
| | - Austin Cohrs
- Department of Public Health Sciences, Pennsylvania State University, USA.
| | - Mariana Dejuk
- College of Medicine, Penn State University, Hershey, PA, USA.
| | - Jinpyo Hong
- College of Medicine, Penn State University, Hershey, PA, USA.
| | - Souvik Sen
- University of South Carolina, Department of Neurology, USA.
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Murthy SB. Emergent Management of Intracerebral Hemorrhage. Continuum (Minneap Minn) 2024; 30:641-661. [PMID: 38830066 DOI: 10.1212/con.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Nontraumatic intracerebral hemorrhage (ICH) is a potentially devastating cerebrovascular disorder. Several randomized trials have assessed interventions to improve ICH outcomes. This article summarizes some of the recent developments in the emergent medical and surgical management of acute ICH. LATEST DEVELOPMENTS Recent data have underscored the protracted course of recovery after ICH, particularly in patients with severe disability, cautioning against early nihilism and withholding of life-sustaining treatments. The treatment of ICH has undergone rapid evolution with the implementation of intensive blood pressure control, novel reversal strategies for coagulopathy, innovations in systems of care such as mobile stroke units for hyperacute ICH care, and the emergence of newer minimally invasive surgical approaches such as the endoport and endoscope-assisted evacuation techniques. ESSENTIAL POINTS This review discusses the current state of evidence in ICH and its implications for practice, using case illustrations to highlight some of the nuances involved in the management of acute ICH.
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Ha WS, Jang K, Cho S, Kim WJ, Chu MK, Heo K, Kim KM. Risk Factors and Temporal Patterns of Poststroke Epilepsy across Stroke Subtypes: Insights from a Nationwide Cohort Study in Korea. Neuroepidemiology 2024:1-11. [PMID: 38599180 DOI: 10.1159/000538776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION We aimed to investigate the risk factors associated with poststroke epilepsy (PSE) among patients with different subtypes of stroke, focusing on age-related risk and time-varying effects of stroke subtypes on PSE development. METHODS A retrospective, nationwide, population-based cohort study was conducted using Korean National Health Insurance Service-National Sample Cohort data. Patients hospitalized with newly diagnosed stroke from 2005 to 2015 were included and followed up for up to 10 years. The primary outcome was the development of PSE, defined as having a diagnostic code and a prescription for anti-seizure medication. Multivariable Cox proportional hazard models were used to estimate PSE hazard ratios (HRs), and time-varying effects were also assessed. RESULTS A total of 8,305 patients with ischemic stroke, 1,563 with intracerebral hemorrhage (ICH), and 931 with subarachnoid hemorrhage (SAH) were included. During 10 years of follow-up, 4.6% of patients developed PSE. Among patients with ischemic stroke, significant risk factors for PSE were younger age (HR = 1.47), living in rural areas (HR = 1.35), admission through the emergency room (HR = 1.33), and longer duration of hospital stay (HR = 1.45). Time-varying analysis revealed elevated HRs for ICH and SAH, particularly in the first 2 years following the stroke. The age-specific HRs also showed an increased risk for those under the age of 65, with a noticeable decrease in risk beyond that age. CONCLUSION The risk of developing PSE varies according to stroke subtype, age, and other demographic factors. These findings underscore the importance of tailored poststroke monitoring and management strategies to mitigate the risk of PSE.
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Affiliation(s)
- Woo-Seok Ha
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kimoon Jang
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Zhang X, Zhang Y, Su Q, Liu Y, Li Z, Yong VW, Xue M. Ion Channel Dysregulation Following Intracerebral Hemorrhage. Neurosci Bull 2024; 40:401-414. [PMID: 37755675 PMCID: PMC10912428 DOI: 10.1007/s12264-023-01118-6] [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: 01/27/2023] [Accepted: 06/14/2023] [Indexed: 09/28/2023] Open
Abstract
Injury to the brain after intracerebral hemorrhage (ICH) results from numerous complex cellular mechanisms. At present, effective therapy for ICH is limited and a better understanding of the mechanisms of brain injury is necessary to improve prognosis. There is increasing evidence that ion channel dysregulation occurs at multiple stages in primary and secondary brain injury following ICH. Ion channels such as TWIK-related K+ channel 1, sulfonylurea 1 transient receptor potential melastatin 4 and glutamate-gated channels affect ion homeostasis in ICH. They in turn participate in the formation of brain edema, disruption of the blood-brain barrier, and the generation of neurotoxicity. In this review, we summarize the interaction between ions and ion channels, the effects of ion channel dysregulation, and we discuss some therapeutics based on ion-channel modulation following ICH.
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Affiliation(s)
- Xiangyu Zhang
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, 450000, China
| | - Yan Zhang
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, 450000, China
| | - Qiuyang Su
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, 450000, China
| | - Yang Liu
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, 450000, China
| | - Zhe Li
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, 450000, China
| | - V Wee Yong
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, University of Calgary, Calgary, AB, T2N 1N4, Canada.
| | - Mengzhou Xue
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
- Academy of Medical Science, Zhengzhou University, Zhengzhou, 450000, China.
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Lekoubou A, Petucci J, Ajala TF, Katoch A, Sen S, Honavar V. Large datasets from Electronic Health Records predict seizures after ischemic strokes: A Machine Learning approach. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.24.24301755. [PMID: 38343819 PMCID: PMC10854320 DOI: 10.1101/2024.01.24.24301755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Objective To develop an artificial intelligence, machine learning prediction model for estimating the risk of seizures 1 year and 5 years after ischemic stroke (IS) using a large dataset from Electronic Health Records. Background Seizures are frequent after ischemic strokes and are associated with increased mortality, poor functional outcomes, and lower quality of life. Separating patients at high risk of seizures from those at low risk of seizures is needed for treatment and clinical trial planning, but remains challenging. Machine learning (ML) is a potential approach to solve this paradigm. Design/Methods We identified patients (aged ≥18 years) with IS without a prior diagnosis of seizures from 2015 until inception (08/09/22) in the TriNetX Research Network, using the International Classification of Diseases, Tenth Revision (ICD-10) I63, excluding I63.6 (venous infarction). The outcome of interest was any ICD-10 diagnosis of seizures (G40/G41) at 1 year and 5 years following the index IS. We applied a conventional logistic regression and a Light Gradient Boosted Machine algorithm to predict the risk of seizures at 1 year and 5 years. The performance of the model was assessed using the area under the receiver operating characteristics (AUROC), the area under the precision-recall curve (AUPRC), F1 statistic, model accuracy, balanced accuracy, precision, and recall, with and without anti-seizure medication use in the models. Results Our study cohort included 430,254 IS patients. Seizures were present in 18,502 (4.3%) and (5.3%) patients within 1 and 5 years after IS, respectively. At 1-year, the AUROC, AUPRC, F1 statistic, accuracy, balanced-accuracy, precision, and recall were respectively 0.7854 (standard error: 0.0038), 0.2426 (0.0048), 0.2299 (0.0034), 0.8236 (0.001), 0.7226 (0.0049), 0.1415 (0.0021), and 0.6122, (0.0095). Corresponding metrics at 5 years were 0.7607 (0.0031), 0.247 (0.0064), 0.2441 (0.0032), 0.8125 (0.0013), 0.7001 (0.0045), 0.155 (0.002) and 0.5745 (0.0095). Conclusion Our findings suggest that ML models show good model performance for predicting seizures after IS.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Milton S. Hershey Medical Center and Department of Public Health, Pennsylvania State University
| | - Justin Petucci
- Institute for Computational and Data Sciences
- Clinical and Translational Sciences Institute
| | | | | | - Souvik Sen
- University of South Carolina, Department of Neurology
| | - Vasant Honavar
- Institute for Computational and Data Sciences
- Clinical and Translational Sciences Institute
- Data Sciences Program
- College of Information Sciences and Technology
- Center for Artificial Intelligence Foundations and Scientific Applications
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Misra S, Khan EI, Lam TT, Mazumder R, Gururangan K, Hickman LB, Goswami V, Funaro MC, Eldem E, Sansing LH, Sico JJ, Quinn TJ, Liebeskind DS, Montaner J, Kwan P, Mishra NK. Common Pathways of Epileptogenesis in Patients With Epilepsy Post-Brain Injury: Findings From a Systematic Review and Meta-analysis. Neurology 2023; 101:e2243-e2256. [PMID: 37550071 PMCID: PMC10727219 DOI: 10.1212/wnl.0000000000207749] [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: 12/07/2022] [Accepted: 09/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy may result from various brain injuries, including stroke (ischemic and hemorrhagic), traumatic brain injury, and infections. Identifying shared common biological pathways and biomarkers of the epileptogenic process initiated by the different injuries may lead to novel targets for preventing the development of epilepsy. We systematically reviewed biofluid biomarkers to test their association with the risk of post-brain injury epilepsy. METHODS We searched articles until January 25, 2022, in MEDLINE, Embase, PsycInfo, Web of Science, and Cochrane. The primary outcome was the difference in mean biomarker levels in patients with and without post-brain injury epilepsy. We used the modified quality score on prognostic studies for risk of bias assessment. We calculated each biomarker's pooled standardized mean difference (SMD) and 95% CI. Molecular interaction network and enrichment analyses were conducted in Cytoscape (PROSPERO CRD42021297110). RESULTS We included 22 studies with 1,499 cases with post-brain injury epilepsy and 7,929 controls without post-brain injury epilepsy. Forty-five biomarkers in the blood or CSF were investigated with samples collected at disparate time points. Of 22 studies, 21 had a moderate-to-high risk of bias. Most of the biomarkers (28/45) were investigated in single studies; only 9 provided validation data, and studies used variable definitions for early-onset and late-onset seizures. A meta-analysis was possible for 19 biomarkers. Blood glucose levels in 4 studies were significantly higher in patients with poststroke epilepsy (PSE) than those without PSE (SMD 0.44; CI 0.19-0.69). From individual studies, 15 biomarkers in the blood and 7 in the CSF were significantly associated with post-brain injury epilepsy. Enrichment analysis identified that the significant biomarkers (interleukin [IL]-6, IL-1β]) were predominantly inflammation related. DISCUSSION We cannot yet recommend using the reported biomarkers for designing antiepileptogenesis trials or use in the clinical setting because of methodological heterogeneity, bias in the included studies, and insufficient validation studies. Although our analyses indicate the plausible role of inflammation in epileptogenesis, this is likely not the only mechanism. For example, an individual's genetic susceptibilities might contribute to his/her risk of epileptogenesis after brain injury. Rigorously designed biomarker studies with methods acceptable to the regulatory bodies should be conducted.
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Affiliation(s)
- Shubham Misra
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Erum I Khan
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - TuKiet T Lam
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Rajarshi Mazumder
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Kapil Gururangan
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - L Brian Hickman
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Vaibhav Goswami
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Melissa C Funaro
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Ece Eldem
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Lauren H Sansing
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Jason J Sico
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Terence J Quinn
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - David S Liebeskind
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Joan Montaner
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Patrick Kwan
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia
| | - Nishant K Mishra
- From the Department of Neurology (S.M., E.E., L.H.S., J.J.S., N.K.M.), Yale University School of Medicine, New Haven, CT; Medical School (E.I.K.), B.J. Medical College and Civil Hospital, Ahmedabad, India; Keck MS & Proteomics Resource (T.T.L.), Yale University School of Medicine, New Haven, CT; Department of Neurology (R.M., K.G., L.B.H., D.S.L.), University of California, Los Angeles; Department of Neurology (K.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (V.G.), Tower Health, Philadelphia, PA; Harvey Cushing/John Hay Whitney Medical Library (M.C.F.), Yale University, New Haven, CT; Department of Immunobiology (L.H.S.), Yale University School of Medicine, New Haven, CT; Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, Scotland, UK; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville; Department of Neurology (J.M.), Hospital Universitario Virgen Macarena, Seville; Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR) (J.M.), Barcelona, Spain; and Department of Neuroscience (P.K.), Central Clinical School, Monash University, Melbourne, Australia.
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7
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Lekoubou A, Nguyen C, Kwon M, Nyalundja AD, Agrawal A. Post-stroke Everything. Curr Neurol Neurosci Rep 2023; 23:785-800. [PMID: 37837566 DOI: 10.1007/s11910-023-01308-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW This review aims at providing updates on selected post-stroke complications. We examined recent advances in diagnosing and treating the following post-stroke complications: cognitive impairment, epilepsy, depression, fatigue, tremors, dysphagia, and pain. RECENT FINDINGS Advances in understanding the mechanisms of post-stroke complications, in general, are needed despite advances made in understanding, treating, and preventing these complications. There are growing progresses in integrating new tools to diagnose post-stroke cognitive impairment. The potential role of acute stroke reperfusion treatment in post-stroke epilepsy and its impact on other stroke complications is getting more transparent. Post-stroke depression remains underestimated and new tools to diagnose depression after stroke are being developed. New promising pharmacological approaches to treating post-stroke pain are emerging. Tremors related to stroke are poorly understood and under-evaluated, while treatment towards post-stroke dysphagia has benefited from new non-pharmacological to pharmacological approaches. CONCLUSIONS An integrative approach to stroke complications and collaborations between providers across specialties are more likely to improve stroke outcomes.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA.
| | - Clever Nguyen
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA
| | - Michelle Kwon
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Center for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of Congo
| | - Ankita Agrawal
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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8
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Seitz A, Parauda SC, Salehi Omran S, Schweitzer AD, Liberman AL, Murthy SB, Merkler AE, Navi BB, Iadecola C, Kamel H, Zhang C, Parikh NS. Long-term risk of seizure after posterior reversible encephalopathy syndrome. Ann Clin Transl Neurol 2023; 10:610-618. [PMID: 36814083 PMCID: PMC10109352 DOI: 10.1002/acn3.51748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Patients with posterior reversible encephalopathy syndrome (PRES) can develop seizures during the acute phase. We sought to determine the long-term risk of seizure after PRES. METHODS We performed a retrospective cohort study using statewide all-payer claims data from 2016-2018 from nonfederal hospitals in 11 US states. Adults admitted with PRES were compared to adults admitted with stroke, an acute cerebrovascular disorder associated with long-term risk of seizure. The primary outcome was seizure diagnosed during an emergency room visit or hospital admission after the index hospitalization. The secondary outcome was status epilepticus. Diagnoses were determined using previously validated ICD-10-CM codes. Patients with seizure diagnoses before or during the index admission were excluded. We used Cox regression to evaluate the association of PRES with seizure, adjusting for demographics and potential confounders. RESULTS We identified 2095 patients hospitalized with PRES and 341,809 with stroke. Median follow-up was 0.9 years (IQR, 0.3-1.7) in the PRES group and 1.0 years (IQR, 0.4-1.8) in the stroke group. Crude seizure incidence per 100 person-years was 9.5 after PRES and 2.5 after stroke. After adjustment for demographics and comorbidities, patients with PRES had a higher risk of seizure than patients with stroke (HR, 2.9; 95% CI, 2.6-3.4). Results were unchanged in a sensitivity analysis that applied a two-week washout period to mitigate detection bias. A similar relationship was observed for the secondary outcome of status epilepticus. INTERPRETATION PRES was associated with an increased long-term risk of subsequent acute care utilization for seizure compared to stroke.
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Affiliation(s)
- Alison Seitz
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Sarah C Parauda
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Ava L Liberman
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Santosh B Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
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9
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Development and validation of a novel radiomics-clinical model for predicting post-stroke epilepsy after first-ever intracerebral haemorrhage. Eur Radiol 2023:10.1007/s00330-023-09429-y. [PMID: 36735039 DOI: 10.1007/s00330-023-09429-y] [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: 07/26/2022] [Revised: 11/05/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Post-stroke epilepsy (PSE) is associated with increased morbidity and mortality. This study aimed to develop and validate a novel prediction model combining clinical factors and radiomics features to accurately identify patients at high risk of developing PSE after intracerebral haemorrhage (ICH). METHODS Researchers performed a retrospective medical chart review to extract derivation and validation cohorts of patients with first-ever ICH that attended two tertiary hospitals in China between 2010 and 2020. Clinical data were extracted from electronic medical records and supplemented by tele-interview. Predictive clinical variables were selected by multivariable logistic regression to build the clinical model. Predictive radiomics features were identified, and a Rad-score was calculated according to the coefficient of the selected feature. Both clinical variables and radiomic features were combined to build the radiomics-clinical model. Performances of the clinical, Rad-score, and combined models were compared. RESULTS A total of 1571 patients were included in the analysis. Cortical involvement, early seizures within 7 days of ICH, NIHSS score, and ICH volume were included in the clinical model. Rad-score, instead of ICH volume, was included in the combined model. The combined model exhibited better discrimination ability and achieved an overall better benefit against threshold probability than the clinical model in the decision curve analysis (DCA). CONCLUSIONS The combined radiomics-clinical model was better able to predict ICH-associated PSE compared to the clinical model. This can help clinicians better predict an individual patient's risk of PSE following a first-ever ICH and facilitate earlier PSE diagnosis and treatment. KEY POINTS • Radiomics has not been used in predicting the risk of developing PSE. • Higher Rad-scores were associated with higher risk of developing PSE. • The combined model showed better performance of PSE prediction ability.
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10
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Late epileptic seizures following cerebral venous thrombosis: a systematic review and meta-analysis. Neurol Sci 2022; 43:5229-5236. [PMID: 35639217 PMCID: PMC9153875 DOI: 10.1007/s10072-022-06148-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022]
Abstract
Background Identifying
late epileptic seizures (LS) following cerebral venous thrombosis (CVT) can be useful for prognosis and management. We systematically reviewed the literature to identify risk factors for LS due to CVT. Methods We systematically searched PubMed, Scholar, and Scopus databases (May 2021) to identify studies reporting data on prevalence and risk factors for CVT-LS. The methodological quality was assessed with the Ottawa-Newcastle Scale. The risk of developing CVT-LS was summarized in meta-analyses and expressed as odds ratio (OR) and corresponding 95% confidence intervals (CIs) using random-effects models. Results Out of the 332 records retrieved, four studies were eventually included with a total of 1309 patients with CVT and 142 (11%) with CVT-LS. The most relevant predictors of CVT-LS were symptomatic seizures (OR 5.66, 95% CI 3.83–8.35), stupor/coma (OR 6.81, 95% CI 1.18–39.20), focal neurologic signs (OR 6.81, 95% CI 1.18–39.2), hemorrhagic component (OR 3.52, 95% CI 2.45–5.06), and superior sagittal sinus involvement (OR 1.52, 95% CI 1.04–2.21). Conclusion There are several risk factors for CVT-LS that should be considered in clinical practice. Further high-quality studies are warranted to develop predictive models for individualized risk stratification and prediction of CVT-LS. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06148-y.
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11
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Lekoubou A, Ba DM, Nguyen C, Liu G, Leslie DL, Bonilha L, Vernon CM. Poststroke Seizures and the Risk of Dementia Among Young Stroke Survivors. Neurology 2022; 99:e385-e392. [PMID: 35584925 PMCID: PMC9421769 DOI: 10.1212/wnl.0000000000200736] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 03/30/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The effect of new-onset seizures in young stroke survivors on the subsequent development of dementia is poorly understood. This study aimed to assess the association between new onset of seizure and dementia in a population-based study of patients with stroke. METHODS The IBM Watson Health MarketScan Commercial Claims and Encounters database for the years 2005-2014 served as the data source for this study. Using the International Classification of Diseases, Ninth Revision (ICD-9), we identified patients aged 18-60 years with ischemic strokes (ISs; 433.x1, 434.x1, and 436) and hemorrhagic strokes (HSs; 430, 431, 432.0, 432.1, and 432.9) between January 1, 2006, and December 31, 2009, which constituted our baseline study cohort. At baseline, all included participants were free of claims for dementia, brain tumors, toxin exposure, traumatic brain injury, and neuroinfectious diseases, identified using ICD-9 codes. They had at least 1-year continuous enrollment before the index stroke diagnosis and 5 years after, with no seizure claims within 1 year after the index date. The exposure of interest was seizures: a time-dependent variable. The study outcome of interest was dementia (ICD-9: 290.0, 290.10-13, 290.20-21, 290.3, 290.40-43, 291.2, 292.82, 294.10-11, 294.20-21, 294.8, 331.0, 331.11, 331.19, and 331.82), which occurred during the follow-up period from January 1, 2010, to December 31, 2014. A Cox proportional hazards regression model was applied to calculate the hazard ratio (HR) and 95% CI for the independent association of seizures with the occurrence of dementia. RESULTS At the end of the baseline period, we identified 23,680 patients with stroke (IS: 20,642 and HS: 3,038). The cumulative incidence of seizure was 6.7%, 6.4%, and 8.3% for all strokes, IS, and HS, respectively. The cumulative incidence of dementia was 1.3%, 1.4%, and 0.9% for all strokes, IS, and HS, respectively. After multivariable adjustment, young patients with stroke who developed seizures had a greater risk of dementia compared with those without seizures (all strokes adjusted HR: 2.53, 95% CI 1.84-3.48; IS: 2.52, 1.79-3.53; HS: 2.80, 1.05-7.43). DISCUSSION These findings suggest that the onset of seizures in young stroke survivors is associated with a 2.53 times increased risk of developing dementia. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that poststroke seizures increase the probability of dementia in young stroke survivors.
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Affiliation(s)
- Alain Lekoubou
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston.
| | - Djibril M Ba
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Clever Nguyen
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Guodong Liu
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Douglas L Leslie
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Leonardo Bonilha
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
| | - Chinchilli M Vernon
- From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston
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12
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Mu S, Li J, Lin K, Fang Y, Lin F, Li Z, Xu Y, Wang S. Predictive Factors for Early-Onset Seizures in Patients With Cerebral Venous Sinus Thrombosis. Front Neurol 2022; 13:842807. [PMID: 35422753 PMCID: PMC9001912 DOI: 10.3389/fneur.2022.842807] [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: 12/24/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Seizures are reported to be important factors contributing to poor prognosis in patients with cerebral venous sinus thrombosis (CVST). However, the predictive factors for concurrent early onset seizures in patients with CVST remain unclear. To identify the predictive factors of early seizures in patients with CVST, this study retrospectively evaluated the clinical data of patients diagnosed with CVST at two centers from January 2011 to December 2020 and analyzed the relationship between admission characteristics and early onset seizures. A total of 112 CVST patients (63 men and 49 women; mean age 39.82 ± 15.70 years) were enrolled in this study, of whom 34 (30.36%) had seizures. For patients with seizures, cerebral hemorrhage, cortical vein thrombosis, anterior superior sagittal sinus (SSS) thrombosis, middle SSS thrombosis, CVST score, modified Rankin Scale, National Institute of Health Stroke Scale (NIHSS) score, neutrophil percentage, and D-dimer level were more severe than those without seizures. Logistic regression analysis showed that cerebral hemorrhage (P = 0.002), anterior SSS thrombosis (P = 0.003), NIHSS score ≥5 (P = 0.003), and D-dimer ≥0.88 mg/L (P = 0.004) were all significant predictive factors of early-onset seizures in CVST patients. Combining the four factors further improved the predictive capability with an area under the curve of 0.871 (95% confidence interval = 0.803–0.939). Further large-scale prospective studies are required to confirm these findings.
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Affiliation(s)
- Shuwen Mu
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jun Li
- Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Kunzhe Lin
- Department of Neurosurgery, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Yi Fang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Feng Lin
- School of Medicine, Xiamen University, Xiamen, China
| | - Ziqi Li
- School of Medicine, Xiamen University, Xiamen, China
| | - Yongjun Xu
- Laboratory of Basic Medicine, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Yongjun Xu
| | - Shousen Wang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Shousen Wang
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13
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MicroRNAs as biomarkers in spontaneous intracerebral hemorrhage: A systematic review of recent clinical evidence. Clin Neurol Neurosurg 2022; 213:107130. [DOI: 10.1016/j.clineuro.2022.107130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/14/2022]
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14
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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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15
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Lin R, Yu Y, Wang Y, Foster E, Kwan P, Lin M, Xia N, Xu H, Xie C, Yang Y, Wang X. Risk of Post-stroke Epilepsy Following Stroke-Associated Acute Symptomatic Seizures. Front Aging Neurosci 2021; 13:707732. [PMID: 34588971 PMCID: PMC8475904 DOI: 10.3389/fnagi.2021.707732] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: Post-stroke epilepsy (PSE) is associated with increased morbidity and mortality. Stroke-associated acute symptomatic seizures are an important risk factor: 20.8–34.3% of these patients will go on to develop PSE. Identifying these “high risk” individuals may result in earlier PSE diagnosis, treatment, and avoidance of seizure-related morbidity. This study was to identify predictors of PSE development in patients with stroke-associated acute symptomatic seizures. Participants and Methods: This was a retrospective cohort study of 167 patients with stroke-associated acute symptomatic seizures admitted to the Neurology Department of a tertiary Hospital of China, from 1 May 2006 to 30 January 2020. Both those with primary ischemic stroke and intracerebral hemorrhage were included in the study. Patient demographics, medical history, stroke-associated, and seizure-related variables were evaluated with univariable analysis and multivariable Cox regression analysis. PSE was defined as unprovoked seizures occurring > 7 days post-stroke. Data points were extracted from medical records and supplemented by tele-interview. Results: Of the 167 patients with stroke-associated acute symptomatic seizures, 49 (29.3%) developed PSE. NIHSS score > 14 [hazard ratio (HR) 2.98, 95% CI 1.57–5.67], longer interval from stroke to acute symptomatic seizures (days 4–7 post-stroke) (HR 2.51, 95% CI 1.37–4.59) and multiple acute symptomatic seizures (HR 5.08, 95% CI 2.58–9.99) were independently associated with PSE development. This association remained in the sub-analysis within the ischemic stroke cohort. In the sub-analysis of the hemorrhagic stroke cohort, multilobar involvement (HR 4.80, 95% CI 1.49–15.39) was also independently associated with development of PSE. Further, we developed a nomogram to predict individual risk of developing PSE following stroke-associated acute symptomatic seizures. The nomogram showed a C-index of 0.73. Conclusion: More severe neurofunctional deficits (NIHSS score > 14), longer interval from stroke to acute symptomatic seizures (days 4–7 post-stroke), and multiple acute symptomatic seizures were independently associated with development of PSE in patients with stroke-associated acute symptomatic seizures. This knowledge may increase clinical vigilance for development of PSE, facilitating rapid diagnosis and treatment initiation, and subsequently reduce seizure-related morbidity.
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Affiliation(s)
- Ru Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yaoyao Yu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Wang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Emma Foster
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Patrick Kwan
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mengqi Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Niange Xia
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huiqin Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenglong Xie
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Alzheimer's Disease of Zhejiang Province, Institute of Aging, Wenzhou Medical University, Wenzhou, China
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16
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Gifreu A, Falip M, Sala-Padró J, Mongay N, Morandeira F, Camins Á, Naval-Baudin P, Veciana M, Fernández M, Pedro J, Garcia B, Arroyo P, Simó M. Risk of Developing Epilepsy after Autoimmune Encephalitis. Brain Sci 2021; 11:brainsci11091182. [PMID: 34573203 PMCID: PMC8468512 DOI: 10.3390/brainsci11091182] [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: 06/30/2021] [Revised: 08/28/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute symptomatic seizures (ASS) are a common manifestation of autoimmune encephalitis (AE), but the risk of developing epilepsy as a sequela of AE remains unknown, and factors predisposing the development of epilepsy have not been fully identified. OBJECTIVE To assess the risk of developing epilepsy in AE and study related risk factors. MATERIALS AND METHODS This was a retrospective single centre study including patients diagnosed with AE according to criteria described by Graus et al., with a minimum follow-up of 12 months after AE resolution. The sample was divided according to whether patients developed epilepsy or not. RESULTS A total of 19 patients were included; 3 (15.8%) had AE with intracellular antibodies, 9 (47.4%) with extracellular antibodies, and 7 (36.8%) were seronegative. During follow-up, 3 patients (15.8%) died, 4 (21.1%) presented relapses of AE, and 11 (57.89%) developed epilepsy. There was a significant association between the development of epilepsy and the presence of hippocampal atrophy in control brain magnetic resonance imaging (MRI) (p = 0.037), interictal epileptiform discharges (IED) on control electroencephalogram (EEG) (p = 0.045), and immunotherapy delay (p = 0.016). CONCLUSIONS Hippocampal atrophy in neuroimaging, IED on EEG during follow-up, and immunotherapy delay could be predictors of the development of epilepsy in patients with AE.
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Affiliation(s)
- Ariadna Gifreu
- Epilepsy Unit, Neurology Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (J.S.-P.)
| | - Mercè Falip
- Epilepsy Unit, Neurology Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (J.S.-P.)
- Correspondence:
| | - Jacint Sala-Padró
- Epilepsy Unit, Neurology Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.G.); (J.S.-P.)
| | - Neus Mongay
- Neurology Ward Unit, Neurology Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.M.); (P.A.)
| | - Francisco Morandeira
- Laboratory Service, Immunology Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Ángels Camins
- MRI Unit, IDI (Institute of Image Diagnosis), Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain; (Á.C.); (P.N.-B.); (M.F.)
| | - Pablo Naval-Baudin
- MRI Unit, IDI (Institute of Image Diagnosis), Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain; (Á.C.); (P.N.-B.); (M.F.)
| | - Misericordia Veciana
- Neurophysiology Department, Neurology Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain; (M.V.); (J.P.); (B.G.)
| | - Montserrat Fernández
- MRI Unit, IDI (Institute of Image Diagnosis), Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, 08907 Barcelona, Spain; (Á.C.); (P.N.-B.); (M.F.)
| | - Jordi Pedro
- Neurophysiology Department, Neurology Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain; (M.V.); (J.P.); (B.G.)
| | - Belia Garcia
- Neurophysiology Department, Neurology Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain; (M.V.); (J.P.); (B.G.)
| | - Pablo Arroyo
- Neurology Ward Unit, Neurology Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.M.); (P.A.)
| | - Marta Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L’Hospitalet (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain;
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Jones FJS, Sanches PR, Smith JR, Zafar SF, Blacker D, Hsu J, Schwamm LH, Newhouse JP, Westover MB, Moura LMVR. Seizure Prophylaxis After Spontaneous Intracerebral Hemorrhage. JAMA Neurol 2021; 78:1128-1136. [PMID: 34309642 PMCID: PMC8314179 DOI: 10.1001/jamaneurol.2021.2249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/10/2021] [Indexed: 12/24/2022]
Abstract
Importance Limited evidence is available concerning optimal seizure prophylaxis after spontaneous intracerebral hemorrhage (sICH). Objective To evaluate which of 4 seizure prophylaxis strategies provides the greatest net benefit for patients with sICH. Design, Setting, and Participants This decision analysis used models to simulate the following 4 common scenarios: (1) a 60-year-old man with low risk of early (≤7 days after stroke) (10%) and late (3.6% or 9.8%) seizures and average risk of short- (9%) and long-term (30%) adverse drug reaction (ADR); (2) an 80-year-old woman with low risk of early (10%) and late (3.6% or 9.8%) seizures and high short- (24%) and long-term (80%) ADR risks; (3) a 55-year-old man with high risk of early (19%) and late (34.8% or 46.2%) seizures and low short- (9%) and long-term (30%) ADR risks; and (4) a 45-year-old woman with high risk of early (19%) and late (34.8% or 46.2%) seizures and high short- (18%) and long-term (60%) ADR risks. Interventions The following 4 antiseizure drug strategies were included: (1) conservative, consisting of short-term (7-day) secondary early-seizure prophylaxis with long-term therapy after late seizure; (2) moderate, consisting of long-term secondary early-seizure prophylaxis or late-seizure therapy; (3) aggressive, consisting of long-term primary prophylaxis; and (4) risk guided, consisting of short-term secondary early-seizure prophylaxis among low-risk patients (2HELPS2B score, 0), short-term primary prophylaxis among patients at higher risk (2HELPS2B score, ≥1), and long-term secondary therapy for late seizure. Main Outcomes and Measures Quality-adjusted life-years (QALYs). Results For scenario 1, the risk-guided strategy (8.13 QALYs) was preferred over the conservative (8.08 QALYs), moderate (8.07 QALYs), and aggressive (7.88 QALYs) strategies. For scenario 2, the conservative strategy (2.18 QALYs) was preferred over the risk-guided (2.17 QALYs), moderate (2.09 QALYs), and aggressive (1.15 QALYs) strategies. For scenario 3, the aggressive strategy (9.21 QALYs) was preferred over the risk-guided (8.98 QALYs), moderate (8.93 QALYs), and conservative (8.77 QALYs) strategies. For scenario 4, the risk-guided strategy (11.53 QALYs) was preferred over the conservative (11.23 QALYs), moderate (10.93 QALYs), and aggressive (8.08 QALYs) strategies. Sensitivity analyses suggested that short-term strategies (conservative and risk guided) are preferred under most scenarios, and the risk-guided strategy performs comparably to or better than alternative strategies in most settings. Conclusions and Relevance This decision analytical model suggests that short-term (7-day) prophylaxis dominates longer-term therapy after sICH. Use of the 2HELPS2B score to guide clinical decisions for initiation of short-term primary vs secondary early-seizure prophylaxis should be considered for all patients after sICH.
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Affiliation(s)
| | - Paula R. Sanches
- Department of Neurology, Massachusetts General Hospital, Boston
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jason R. Smith
- Department of Neurology, Massachusetts General Hospital, Boston
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sahar F. Zafar
- Department of Neurology, Massachusetts General Hospital, Boston
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Deborah Blacker
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - John Hsu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Mongan Institute for Health Policy, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Joseph P. Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Michael B. Westover
- Department of Neurology, Massachusetts General Hospital, Boston
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Lidia M. V. R. Moura
- Department of Neurology, Massachusetts General Hospital, Boston
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
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18
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Jones FJ, Sanches PR, Smith JR, Zafar SF, Hernandez-Diaz S, Blacker D, Hsu J, Schwamm LH, Westover MB, Moura LM. Anticonvulsant Primary and Secondary Prophylaxis for Acute Ischemic Stroke Patients: A Decision Analysis. Stroke 2021; 52:2782-2791. [PMID: 34126758 PMCID: PMC8384723 DOI: 10.1161/strokeaha.120.033299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose We examined the impact of 3 anticonvulsant prophylaxis strategies on quality-adjusted life-years (QALYs) among patients with an incident acute ischemic stroke. Methods We created a decision tree to evaluate 3 strategies: (1) long-term primary prophylaxis; (2) short-term secondary prophylaxis after an early seizure with lifetime prophylaxis if persistent or late seizures (LSs) developed; and (3) long-term secondary prophylaxis if either early, late, or persistent seizures developed. The outcome was quality-adjusted life expectancy (QALY). We created 4 base cases to simulate common clinical scenarios: (1) female patient aged 40 years with a 2% or 11% lifetime risk of an LS and a 33% lifetime risk of an adverse drug reaction (ADR); (2) male patient aged 65 years with a 6% or 29% LS risk and 60% ADR risk; (3) male patient aged 50 years with an 18% or 65% LS risk and 33% ADR risk; and (4) female patient aged 80 years with a 29% or 83% LS risk and 80% ADR risk. In sensitivity analyses, we altered the parameters and assumptions. Results Across all 4 base cases, primary prophylaxis yielded the fewest QALYs when compared with secondary prophylaxis. For example, under scenario 1, strategies 2 and 3 resulted in 7.17 QALYs each, but strategy 1 yielded only 6.91 QALYs. Under scenario 4, strategies 2 and 3 yielded 2.85 QALYs compared with 1.40 QALYs for strategy 1. Under scenarios in which patients had higher ADR risks, strategy 2 led to the most QALYs. Conclusions Short-term therapy with continued anticonvulsant prophylaxis only after postischemic stroke seizures arise dominates lifetime primary prophylaxis in all scenarios examined. Our findings reinforce the necessity of close follow-up and discontinuation of anticonvulsant seizure prophylaxis started during acute ischemic stroke hospitalization.
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Affiliation(s)
- Felipe J.S. Jones
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paula R. Sanches
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Jason R. Smith
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sahar F. Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - John Hsu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Michael B. Westover
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Lidia M.V.R. Moura
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
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19
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Risk models to predict late-onset seizures after stroke: A systematic review. Epilepsy Behav 2021; 121:108003. [PMID: 34029995 DOI: 10.1016/j.yebeh.2021.108003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE We performed a systematic review to evaluate available risk models to predict late seizure onset among stroke survivors. METHODS We searched major databases (PubMed, SCOPUS, and Cochrane Library) from inception to October 2020 for articles on the development and/or validation of risk models to predict late seizures after a stroke. The impact of models to predict late-onset seizures was also assessed. We included seven articles in the final analysis. For each of these studies, we evaluated the study design and scope of predictors analyzed to derive each model. We assessed the performance of the models during internal and external validation in terms of discrimination and calibration. RESULTS Three studies focused on ischemic stroke alone, with c-statistic values ranging from 0.73 to 0.77. The SeLECT model from Switzerland was externally validated in Italian, German, and Austrian cohorts where c-statistics ranged from 0.69 to 0.81. This model along with the PSEiCARe model, were internally validated and calibration performance was provided for both models. The CAVS and CAVE models reported on the risk of late-onset seizures in patients with hemorrhagic stroke. The CAVS model derivation cohort was racially diverse. The CAVS model's c-statistic was 0.76, while the CAVE model had a c-statistic of 0.81. Calibration and internal validation were not performed for either study. The CAVS model, created from a Finnish population, was externally validated in American and French cohorts, with c-statistics of 0.73 and 0.69, respectively. Finally, the two studies focusing on both types of stroke came from the PoSERS and INPOSE models. Neither model provided c-statistics, calibration metrics, internal or external validation information. We found no evidence of the presence of impact studies to assess the effect of adopting late-onset seizure risk models after stroke on clinical outcomes. CONCLUSION The SeLECT model was the only model developed in line with proposed guidelines for appropriate model development. The model, which was externally validated in a very similar and homogeneous population, may need to be tested in a more racially/ethnic diverse and younger population; testing the SeLECT model, accounting for overall brain health is likely to improve the identification of high-risk patients for late post stroke seizures.
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20
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Incidence rate and risk factors of status epilepticus after stroke. Seizure 2021; 91:491-498. [PMID: 34358846 DOI: 10.1016/j.seizure.2021.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose To evaluate the incidence rate and risk factors for status epilepticus (SE) after stroke (PSSE), including ischaemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Methods A meta-analysis was performed using relevant research from databases such as PubMed, Embase, Cochrane Online Library, and Clinicaltrials.gov. The quality of the studies was evaluated by using the quality evaluation criteria of the Agency for Healthcare Research and Quality (AHRQ). All data were pooled by STATA 12.0 software for meta-analysis. Results The review considered 1650 articles, and 17 articles with 2821 instances of SE among 1088087 instances of stroke were included. The incidence rate of SE after stroke was 6.90 per 1000 total strokes (95% CI: 5.58-8.22). By subgroup analysis of SE, the rates were 33.85‰ (95% CI: 13.77-53.94) for non-convulsive status epilepticus (NCSE) and 2.42‰ (95%CI: 1.66-3.19) for generalized convulsive status epilepticus (GCSE). Age, sex, and presence of atrial fibrillation showed no significant difference between the SE group and the non-SE group after stroke. Hypertension and diabetes are associated with a decreased rate of SE. However, African American race, alcohol abuse, and renal disease are associated with an increased rate of SE. Significance There were approximately 6.9 patients with status epilepticus per 1000 strokes. NCSE is more common after stroke and needs more attention. African American race, alcohol abuse and renal disease may be risk factors for PSSE.
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21
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Doerrfuss JI, Kowski AB, Holtkamp M. Etiology-specific response to antiseizure medication in focal epilepsy. Epilepsia 2021; 62:2133-2141. [PMID: 34328218 DOI: 10.1111/epi.17017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE In focal epilepsy, data on the etiology-specific response to antiseizure medication (ASM) are surprisingly sparse. In this study, we sought to reappraise whether seizure outcome of pharmacological treatment is linked to the underlying etiology. Furthermore, we assessed ASM load with respect to the cause of epilepsy. METHODS Data were retrospectively obtained from the electronic database of the three sites of an academic adult epilepsy outpatient clinic. For each patient, presumed cause of epilepsy was categorized into one of nine etiological groups. Individual drug loads were calculated according to the 2020 World Health Organization Center for Drug Statistics Methodology ATC/DDD Index. Univariate and multivariate analyses were conducted to explore the association between different etiologies and outcome regarding 12-month seizure freedom as well as ASM load. RESULTS A total of 591 patients with focal epilepsy were included in the final analysis. Ischemic stroke was the etiology with the highest rate of 12-month terminal seizure freedom (71.2%, 95% confidence interval [CI] = 57.9-82.2) and, considering all etiological groups, was an independent predictor of seizure freedom (odds ratio = 2.093, 95% CI = 1.039-4.216). The lowest rates of seizure freedom were observed in patients with hippocampal sclerosis (28.2%, 95% CI = 15.0-44.9) and malformation of cortical development (16.7%, 95% CI = 2.1-48.4). In patients with ischemic stroke, median ASM load (1.0, interquartile range [IQR] = .5-1.8) was significantly lower compared to that in patients with hippocampal sclerosis (median = 1.8, IQR = 1.2-3.0, p = .008) and brain tumors (median = 1.7, IQR = .7-3.2, p = .049). SIGNIFICANCE Response to treatment with ASM is highly etiology-specific and best in patients with epilepsy due to ischemic stroke. Interestingly, this most favorable treatment outcome can be achieved by the lowest ASM load considering all etiological groups. In focal epilepsy, etiology should be taken into account when counseling patients about their expected seizure outcome with pharmacological treatment and when tailoring initial ASM doses.
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Affiliation(s)
- Jakob I Doerrfuss
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander B Kowski
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
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22
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Tinti L, Beretta S, Coppo A, Bianchi E, Zanchi C, Carone D, Stabile A, Padovano G, Sulmina E, Greco G, Diamanti S, DiFrancesco JC, Bogliun G, Foti G, Ferrarese C, Beghi E, Avalli L. Long-term risk of chronic epilepsy in adults after post-anoxic coma and refractory status epilepticus: a retrospective cohort study. J Neurol Neurosurg Psychiatry 2021; 92:793-794. [PMID: 33361409 DOI: 10.1136/jnnp-2020-324767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/15/2020] [Accepted: 11/25/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Lorenzo Tinti
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy .,University of Milan-Bicocca, Milano, Italy
| | - Simone Beretta
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca, Milano, Italy
| | - Anna Coppo
- University of Milan-Bicocca, Milano, Italy.,Department of Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Elisa Bianchi
- Neurological Disorders, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Clara Zanchi
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca, Milano, Italy
| | - Davide Carone
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca, Milano, Italy
| | - Andrea Stabile
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca, Milano, Italy
| | - Giada Padovano
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca, Milano, Italy
| | - Endrit Sulmina
- University of Milan-Bicocca, Milano, Italy.,Department of Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Gianluca Greco
- University of Milan-Bicocca, Milano, Italy.,Department of Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Susanna Diamanti
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca, Milano, Italy
| | - Jacopo Cosimo DiFrancesco
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca, Milano, Italy
| | - Graziella Bogliun
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca, Milano, Italy
| | - Giuseppe Foti
- University of Milan-Bicocca, Milano, Italy.,Department of Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Carlo Ferrarese
- Epilepsy Center, Department of Neurology, San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca, Milano, Italy
| | - Ettore Beghi
- Neurological Disorders, Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Leonello Avalli
- University of Milan-Bicocca, Milano, Italy.,Department of Intensive Care, San Gerardo Hospital, Monza, Italy
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23
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Hardtstock F, Foskett N, Gille P, Joeres L, Molzan M, Wilson JC, Wilke T, Holtkamp M. Poststroke epilepsy incidence, risk factors and treatment: German claims analysis. Acta Neurol Scand 2021; 143:614-623. [PMID: 33626184 PMCID: PMC8248362 DOI: 10.1111/ane.13403] [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: 08/10/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 01/09/2023]
Abstract
Objectives To describe incidence, risk factors, and treatment of poststroke epilepsy (PSE) in Germany based on claims data. Methods Retrospective analysis of claims data from a German public sickness fund (AOK PLUS). Patients with acute stroke hospitalizations from January 01, 2011 and December 31, 2015 (index hospitalization) were followed for 12–72 months. Outcomes included incidence of PSE (patients with ≥2 seizure claims [during/after index hospitalization], or ≥1 seizure claim after index hospitalization), multivariate Cox‐regression analyses of time to seizure claim and death after index stroke hospitalization discharge, and antiepileptic drug (AED) treatment. Results Among 53 883 patients with stroke (mean follow‐up of 829.05 days [median 749]), 6054 (11.24%) had ≥1 seizure claim (mean age 73.95 years, 54.18% female). 2130 (35.18%) patients had a seizure claim during index hospitalization (indicative of acute symptomatic seizures). Estimated incidence of PSE (cases/1000 patient‐years) was 94.49 within 1 year. Risk of seizure claim following hospital discharge was higher in patients with hemorrhagic stroke (hazard ratio [HR] =1.13; p <.001) vs those with cerebral infarction. Seizure claim during index hospitalization was a risk factor for seizure claims after hospital discharge (HR =6.97; p <.001) and early death (HR =1.78; p <.001). In the first year of follow‐up, AEDs were prescribed in 73.75% of patients with seizure claims. Conclusions Incidence of PSE was in line with previous studies. Hemorrhagic stroke and seizure claim during index hospitalization were risk factors for seizure claims after hospital discharge. Most patients with seizure claims received AED treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Martin Holtkamp
- Department of Neurology, Epilepsy‐Center Berlin‐Brandenburg Charité – Universitätsmedizin Berlin Berlin Germany
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24
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Räty S, Sallinen H, Virtanen P, Haapaniemi E, Wu TY, Putaala J, Meretoja A, Tatlisumak T, Strbian D. Occipital intracerebral hemorrhage-clinical characteristics, outcome, and post-ICH epilepsy. Acta Neurol Scand 2021; 143:71-77. [PMID: 32602110 DOI: 10.1111/ane.13303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/09/2020] [Accepted: 06/21/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Posterior location affects the clinical presentation and outcome of ischemic stroke, but little is known about occipital intracerebral hemorrhage (ICH). We studied non-traumatic occipital ICH phenotype, outcome, and post-ICH epilepsy. MATERIALS AND METHODS Occipital ICH patients were retrospectively identified from the Helsinki ICH Study registry of 1013 consecutive ICH patients treated in our tertiary center in 2005-2010. They were compared to non-occipital ICH patients to evaluate the effect of location on functional outcome at discharge (dichotomized modified Rankin Scale, mRS), 3- and 12-month mortality, and incidence of epilepsy. RESULTS We found 19 occipital ICH patients (5.3% of lobar and 1.9% of all ICH). Compared to non-occipital lobar ICHs, they were younger (median age 63 vs 71 years, P = .007) and had lower National Institutes of Health Stroke Scale on admission (1 vs 8, P < .001), smaller hematoma volume (6.3 vs 17.7 ML, P = .008), and more frequently structural etiology underlying the ICH (26% vs 7%, P = .01). Mortality at both 3 and 12 months was 6%, whereas 84% reached favorable outcome (mRS 0-2) at discharge. Occipital location was associated with favorable outcome at discharge in lobar ICH (OR 11.02, 95% CI 1.55-78.20). Incidence of post-ICH epilepsy (median follow-up 2.7 years) was 18%, equaling to that of non-occipital lobar ICH. CONCLUSIONS Occipital ICH patients are younger, have less severe clinical presentation, smaller hematoma volume, more often structural etiology, and better outcome than other ICH patients. They exhibit a similar risk of epilepsy as non-occipital ICHs.
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Affiliation(s)
- Silja Räty
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Hanne Sallinen
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Pekka Virtanen
- Radiology, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Elena Haapaniemi
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital New Zealand Brain Research Institute Christchurch New Zealand
| | - Jukka Putaala
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Atte Meretoja
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Turgut Tatlisumak
- Department of Clinical Neurosciences/Neurology, Institute of Neurosciences and Physiology Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Daniel Strbian
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
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25
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Abstract
In an aging society, epilepsy in old age will become a more and more relevant disease. The diagnosis is often difficult because of the frequent occurrence of focal seizures in old age, which are easily overlooked. The diagnosis is often delayed, particularly in older patients who, for example also suffer from dementia. The causes of the epilepsy can be manifold in the aging brain. Another challenge for neurologists is the medicinal treatment of geriatric epilepsy, as many anticonvulsive drugs can be associated with serious side effects and interactions. The evidence for the effectiveness and tolerability of anticonvulsive drugs in old age is insufficient, so that the choice of drugs must be made on an individual basis. Status epilepticus is a neurological emergency, which occurs not only more frequently in older than in younger persons but is also associated with a higher mortality, so that immediate diagnosis and adequate treatment is necessary.
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Affiliation(s)
- Kai Siebenbrodt
- Epilepsiezentrum Frankfurt Rhein-Main, Klinik für Neurologie, Zentrum der Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Deutschland.
| | - Adam Strzelczyk
- Epilepsiezentrum Frankfurt Rhein-Main, Klinik für Neurologie, Zentrum der Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Deutschland
| | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main, Klinik für Neurologie, Zentrum der Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Deutschland
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26
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Yamada S, Nakagawa I, Tamura K, Nishimura F, Motoyama Y, Park YS, Nakase H. Investigation of poststroke epilepsy (INPOSE) study: a multicenter prospective study for prediction of poststroke epilepsy. J Neurol 2020; 267:3274-3281. [PMID: 32561989 DOI: 10.1007/s00415-020-09982-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Poststroke epilepsy is a common problem in clinical practice. This study aimed to determine the predictors of poststroke epilepsy and to identify the risk factors. METHODS A total of 436 patients were enrolled for this study. Baseline characteristics were recorded. Patients were followed up for 3 years. According to the occurrence of late seizures (i.e., seizure occurring 8 days or later after the stroke), the patients were separated into two groups: a seizure group and a seizure-free group. Baseline characteristics were compared between the groups. Univariate and multivariate Cox regression analysis was used to identify the risk factors for occurrence of poststroke epilepsy. The study was registered in the University Hospital Medical Information Network Center Clinical Trials Registry (registration number UMIN000009659, date 28/December/2012). RESULTS Among the 436 patients, 26 developed late seizures-an incidence rate of 5.96%. In univariate analysis, female, subarachnoid hemorrhage, hemorrhagic lesion, lesion affecting the cortex, lesion affecting the frontal lobe, and absence of comorbidities were the significant risk factors for occurrence of epilepsy. In multivariate analysis, the independent predictors of poststroke epilepsy were hemorrhagic lesion (hazard ratio (HR) = 3.03) and lesion location in the cortex (HR = 4.64). The incidence of poststroke epilepsy in patients with both two risk factors was 15.4%. CONCLUSIONS Poststroke epilepsy occurs in almost 6% of patients within 3 years after stroke onset. Hemorrhagic stroke and subcortical lesion appear to be significantly associated with likelihood of developing epilepsy. Thus, prophylactic administration of antiepileptic drugs could be useful for stroke patients with these two risk factors.
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Affiliation(s)
- Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan.
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Kentaro Tamura
- Department of Neurosurgery, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, 840, Shijo-cho, Kashihara, Nara, Japan
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Parikh NS, Salehi Omran S, Kamel H, Elkind MSV, Willey JZ. Smoking-cessation pharmacotherapy for patients with stroke and TIA: Systematic review. J Clin Neurosci 2020; 78:236-241. [PMID: 32334957 DOI: 10.1016/j.jocn.2020.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022]
Abstract
Data regarding the efficacy and safety of smoking-cessation pharmacotherapy after stroke are lacking. We systematically reviewed data on this topic by searching Medline, Cochrane, and Clinicaltrials.gov to identify randomized clinical trials (RCT) and observational studies that assessed the efficacy and safety of nicotine replacement therapy (NRT), varenicline, and bupropion in patients with stroke and TIA. We included studies that reported rates of smoking cessation, worsening or recurrent cerebrovascular disease, seizures, or neuropsychiatric events. We identified 2 RCTs and 6 observational studies; 3 included ischemic stroke and TIA, 2 subarachnoid hemorrhage (SAH), and 3 did not specify. Four studies assessed efficacy; cessation rates ranged from 33% to 66% with pharmacological therapy combined with behavioral interventions versus 15% to 46% without, but no individual study demonstrated a statistically significant benefit. Safety data for varenicline and buopropion in ischemic stroke were scarce. Patients with SAH who received NRT had more seizures (9% vs 2%; P = 0.024) and delirium (19% vs 7%; P = 0.006) in one study, but less frequent vasospasm in 3 studies. In conclusion, combined with behavioral interventions, smoking-cessation therapies resulted in numerically higher cessation rates. Limited safety data may prompt caution regarding seizures and delirium in patients with subarachnoid hemorrhage.
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Affiliation(s)
- Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
| | | | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Joshua Z Willey
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University New York, NY, USA
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28
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Gasparini S, Ascoli M, Brigo F, Cianci V, Branca D, Arcudi L, Aguglia U, Belcastro V, Ferlazzo E. Younger age at stroke onset but not thrombolytic treatment predicts poststroke epilepsy: An updated meta-analysis. Epilepsy Behav 2020; 104:106540. [PMID: 31677999 DOI: 10.1016/j.yebeh.2019.106540] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022]
Abstract
AIMS Stroke is the most commonly identified cause of late-onset epilepsy. Risk factors for poststroke epilepsy (PSE) are partially elucidated, and many studies have been performed in recent years. We aimed to update our previous systematic review and meta-analysis on risk factors for PSE. METHODS PubMed, Google Scholar, and Scopus databases were searched. Articles published in English (1987-2019) were included. Odds ratios (OR) and mean values were calculated for examined variables. RESULTS Thirty studies with different designs were included, enrolling 26,045 patients who experienced stroke, of whom 1800 had PSE, corresponding to a prevalence of 7%. Cortical lesions (OR: 3.58, 95% confidence interval (CI): 2.35-5.46, p < 0.001), hemorrhagic component (OR: 2.47, 95% CI: 1.68-3.64, p < 0.001), early seizures (ES) (OR: 4.88, 95% CI: 3.08-7.72, p < 0.001), and younger age at stroke onset (difference in means: 2.97 years, 95% CI: 0.78 to 5.16, p = 0.008) favor PSE. Sex and acute treatment with recombinant tissue plasminogen activator (rtPA) do not predict the occurrence of PSE. CONCLUSION Despite limitations due to the uneven quality and design of the studies, the present meta-analysis confirms that cortical involvement, hemorrhagic component, and ES are associated with a higher risk of PSE. In this update, younger age at stroke onset but not thrombolytic treatment seems to increase the risk for PSE. This article is part of the Special Issue "Seizures & Stroke".
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Affiliation(s)
- Sara Gasparini
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy; Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Michele Ascoli
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy; Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Hospital Franz Tappeiner, Department of Neurology, Merano, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Damiano Branca
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Luciano Arcudi
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy; Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
| | | | - Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy; Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
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29
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Iwuchukwu I, Nguyen D, Beavers M, Tran V, Sulaiman W, Fannin E, Lasseigne L, Ramsay E, Wilson J, Bazan NG. MicroRNA Regulatory Network as Biomarkers of Late Seizure in Patients with Spontaneous Intracerebral Hemorrhage. Mol Neurobiol 2020; 57:2346-2357. [PMID: 32040835 DOI: 10.1007/s12035-020-01872-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/22/2019] [Indexed: 12/21/2022]
Abstract
Approximately 15% of patients experience seizures after spontaneous intracerebral hemorrhage (ICH). The pathogenesis of seizures post-ICH is not well-known; however, iron deposition-related neuronal injury following hemoglobin breakdown may contribute. Profiling known miRNAs to identify biomarkers for post-ICH late seizures, we found 64 differentially expressed miRNA: 32 upregulated and 32 downregulated in seizure vs. non-seizure. Functional classification of upregulated miRNA for KEGG pathways and biological processes identified enrichment for cell cycle, protein modifications, and FoxO neurotrophin signaling pathways. No significant enrichment was found for downregulated miRNA. Molecular functions Gene Ontology (GO) terms enriched for upregulated miRNA are numerous, while downregulated miRNAs were associated with ion channel activity. RT-PCR confirmed two miRNAs, 4317 and 4325, were differentially expressed in patients who developed seizures at 1 year. MiR-4317 regulates SLC38A1, a glutamine-glutamate transporter. Integrated miRNA-mRNA network analysis identified COMMD6, APOBEC2, and RASSF6-involved in NF-kB regulation. Two miRNAs (miR-4317 and 4325) differentiated post-ICH late seizures vs. non-seizures at 1 year. The results suggest functional and miRNA-mRNA networks as potential biomarkers for post-ICH late seizures.
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Affiliation(s)
- Ifeanyi Iwuchukwu
- Neurocritical Care and Neurology, University of Queensland, Ochsner Clinical School, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA. .,Institute of Translational Research, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA. .,Neuroscience Center of Excellence, Louisiana State University Health New Orleans, School of Medicine, 2020 Gravier Street, 8th Floor, New Orleans, LA, 70112, USA.
| | - Doan Nguyen
- Institute of Translational Research, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Michelle Beavers
- Institute of Translational Research, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Vi Tran
- Institute of Translational Research, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Wale Sulaiman
- Neurosurgery, Ochsner Neuroscience Institute, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Erin Fannin
- Department of Neurosurgery, Louisiana State University Health New Orleans, School of Medicine, 2020 Gravier Street, 7th Floor, New Orleans, LA, 70112, USA
| | - Lindsay Lasseigne
- Department of Neurosurgery, Louisiana State University Health New Orleans, School of Medicine, 2020 Gravier Street, 7th Floor, New Orleans, LA, 70112, USA
| | - Eugene Ramsay
- Neurocritical Care and Neurology, University of Queensland, Ochsner Clinical School, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Jason Wilson
- Department of Neurosurgery, Louisiana State University Health New Orleans, School of Medicine, 2020 Gravier Street, 7th Floor, New Orleans, LA, 70112, USA
| | - Nicolas G Bazan
- Neuroscience Center of Excellence, Louisiana State University Health New Orleans, School of Medicine, 2020 Gravier Street, 8th Floor, New Orleans, LA, 70112, USA
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30
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Jia Q, Jiang F, Ma D, Li J, Wang F, Wang Z. Association Between IL-6 and Seizure Recurrence in Patients with the First Post-Ischemic Stroke Seizure. Neuropsychiatr Dis Treat 2020; 16:1955-1963. [PMID: 32848401 PMCID: PMC7429209 DOI: 10.2147/ndt.s257870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/13/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To study the association between IL-6 level and seizure recurrence in patients with the first post-ischemic stroke seizure and assess its predictive value for seizure recurrence. PATIENTS AND METHODS A total of 2976 consecutive ischemic stroke patients were retrospectively enrolled. Among them, 209 (7.02%) patients with the first post-ischemic stroke seizure were included in this analysis. The IL-6 mRNA expression level was evaluated through quantitative real-time PCR (qRT-PCR) and the 2-ΔΔCt method. Demographic data and clinical characteristics were collected. Univariate analysis was performed with independent-samples t-test, Mann-Whitney U-test, or chi-square test. Multivariate analysis was conducted using a backward stepwise logistic regression model for variables with P<0.10 in univariate analysis. The predictive value was assessed using a receiver operating characteristic (ROC) curve. RESULTS Among the patients included, 105 (50.24%) had recurrence of seizures, and 104 (49.76%) had no recurrence. Multivariate analysis demonstrated that the IL-6 mRNA expression level was independently correlated with seizure recurrence in patients with the first post-ischemic stroke seizure after adjusting for age, NIHSS scores, time of seizure, seizure type, lesion size, location of the offending lesion to different hemispheric lobes, cortical involvement, gender, electroencephalography (EEG) findings, and hemorrhagic transformation. When the IL-6 mRNA expression level was used to predict seizure recurrence, the area under the ROC curve (AUC) was 0.763 (SE=0.033, 95% CI=0.698-0.829). The diagnostic power was moderate. CONCLUSION IL-6 was independently correlated with seizure recurrence in patients with the first post-ischemic stroke seizure and might be a potential biomarker for prediction of seizure recurrence.
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Affiliation(s)
- Qi Jia
- Encephalopathy Center, The Third People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, People's Republic of China
| | - Fan Jiang
- Neonatal Intensive Care Unit, The First People's Hospital of Urumqi, Urumqi 830000, People's Republic of China
| | - Daliang Ma
- Encephalopathy Center, The Third People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, People's Republic of China
| | - Jun Li
- Encephalopathy Center, The Third People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, People's Republic of China
| | - Fan Wang
- Encephalopathy Center, The Third People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, People's Republic of China
| | - Zhiqiang Wang
- Encephalopathy Center, The Third People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, People's Republic of China
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31
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Glibenclamide, a Sur1-Trpm4 antagonist, does not improve outcome after collagenase-induced intracerebral hemorrhage. PLoS One 2019; 14:e0215952. [PMID: 31042750 PMCID: PMC6494051 DOI: 10.1371/journal.pone.0215952] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 12/16/2022] Open
Abstract
The sulfonylurea 1 transient receptor potential melastatin 4 (Sur1-Trpm4) receptor is selectively expressed after intracerebral hemorrhage (ICH). This upregulation contributes to increases in intracellular sodium. Water follows sodium through aquaporin channels, leading to cytotoxic edema. Even after edema is thought to have resolved, ionic dyshomeostasis persists, as does blood-brain barrier (BBB) damage. Glibenclamide, a hypoglycemic agent that inhibits Sur1-Trpm4, has been shown to reduce BBB damage and edema following infusion of autologous blood into the brain (ICH) as well as after other brain injuries. In order to further assess efficacy, we used the collagenase ICH model in rats to test whether glibenclamide reduces edema, attenuates ion dyshomeostasis, improves BBB damage, and reduces lesion volume. We tested a widely-used glibenclamide dose shown effective in other studies (10 μg/kg loading dose followed by 200 ng/hr for up to 7 days). Early initiation of glibenclamide did not significantly impact edema (72 hours), BBB permeability (72 hours), or lesion volume after ICH (28 days). Recovery from neurological impairments was also not improved by glibenclamide. These results suggest that glibenclamide will not improve outcome in ICH. However, the treatment appeared to be safe as there was no effect on bleeding or other physiological variables.
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32
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Moura LMVR, Smith JR, Blacker D, Vogeli C, Schwamm LH, Hsu J. Medicare claims can identify post-stroke epilepsy. Epilepsy Res 2019; 151:40-47. [PMID: 30780120 DOI: 10.1016/j.eplepsyres.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/31/2018] [Accepted: 02/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE There have been no validated Medicare claims-based algorithms available to identify epilepsy by discrete etiology of stroke (e.g., post-stroke epilepsy, PSE) in community-dwelling elderly individuals, despite the increasing availability of large datasets. Our objective was to validate algorithms that detect which patients have true PSE. METHODS We linked electronic health records (EHR) to Medicare claims from a Medicare Pioneer Accountable Care Organization (ACO) to identify PSE. A neurologist reviewed 01/2012-12/2014 EHR data from a stratified sample of Medicare patients aged 65+ years to adjudicate a reference-standard to develop an algorithm for identifying patients with PSE. Patient sampling strata included those with: A) epilepsy-related claims diagnosis (n = 534 [all]); B) no diagnosis but neurologist visit (n = 500 [randomly sampled from 4346]); C) all others (n = 500 [randomly sampled from 16,065]). We reconstructed the full sample using inverse probability sampling weights; then used half to derive algorithms and assess performance, and the remainder to confirm performance. We evaluated predictive performance across several measures, e.g., specificity, sensitivity, negative and positive predictive values (NPV, PPV). We selected our best performing algorithms based on the greatest specificity and sensitivity. RESULTS Of 20,943 patients in the reconstructed sample, 13.6% of patients with epilepsy had reference-standard PSE diagnosis, which represents a 3-year overall prevalence of 0.28% or 28/10,000, and a prevalence within the subpopulation with stroke of 3%. The best algorithm included three conditions: (a) at least one cerebrovascular claim AND one epilepsy-specific anticonvulsant OR (b) at least one cerebrovascular claim AND one electroencephalography claim (specificity 100.0% [95% CI 99.9%-100.0%], NPV 98.8% [98.6%-99.0%], sensitivity 20.6% [95% CI 14.6%-27.9%], PPV 86.5% [95% CI 71.2%-95.5%]). CONCLUSION Medicare claims can identify elderly Medicare beneficiaries with PSE with high accuracy. Future epidemiological surveillance of epilepsy could incorporate similar algorithms to accurately identify epilepsy by varying etiologies.
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Affiliation(s)
- Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Department of Neurology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Jason R Smith
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Christine Vogeli
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Neurology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - John Hsu
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA, 02114, USA; Department of Health Care Policy, Harvard Medical School, 677 Huntington Avenue, Boston, MA, 02115, USA.
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Pinho J, Costa AS, Araújo JM, Amorim JM, Ferreira C. Intracerebral hemorrhage outcome: A comprehensive update. J Neurol Sci 2019; 398:54-66. [PMID: 30682522 DOI: 10.1016/j.jns.2019.01.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/22/2018] [Accepted: 01/11/2019] [Indexed: 12/15/2022]
Abstract
Non-traumatic intracerebral hemorrhage (ICH) is associated with a significant global burden of disease, and despite being proportionally less frequent than ischemic stroke, in 2010 it was associated with greater worldwide disability-adjusted life years lost. The focus of outcome assessment after ICH has been mortality in most studies, because of the high early case fatality which reaches 40% in some population-based studies. The most robust and consistent predictors of early mortality include age, severity of neurological impairment, hemorrhage volume and antithrombotic therapy at the time of the event. Long-term outcome assessment is multifaceted and includes not only mortality and functional outcome, but also patient self-assessment of the health-related quality of life, occurrence of cognitive impairment, psychiatric disorders, epileptic seizures, recurrent ICH and subsequent thromboembolic events. Several scores which predict mortality and functional outcome after ICH have been validated and are useful in the daily clinical practice, however they must be used in combination with the clinical judgment for individualized patients. Management of patients with ICH both in the acute and chronic phases, requires health care professionals to have a comprehensive and updated perspective on outcome, which informs decisions that are needed to be taken together with the patient and next of kin.
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Affiliation(s)
- João Pinho
- Neurology Department, Hospital de Braga, Portugal.
| | - Ana Sofia Costa
- Department of Neurology, RWTH Aachen University Hospital, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
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Wilkinson CM, Fedor BA, Aziz JR, Nadeau CA, Brar PS, Clark JJA, Colbourne F. Failure of bumetanide to improve outcome after intracerebral hemorrhage in rat. PLoS One 2019; 14:e0210660. [PMID: 30629699 PMCID: PMC6328169 DOI: 10.1371/journal.pone.0210660] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022] Open
Abstract
After intracerebral hemorrhage (ICH), brain edema commonly occurs and can cause death. Along with edema, there are significant alterations in the concentrations of key ions such as sodium, potassium, and chloride, which are essential to brain function. NKCC1, a cation-chloride cotransporter, is upregulated after brain damage, such as traumatic injury and ischemic stroke. NKCC1 brings sodium and chloride into the cell, possibly worsening ion dyshomeostasis. Bumetanide, a specific NKCC1 antagonist, blocks the transport of chloride into cells, and thus should attenuate the increases in chloride, which should lessen brain edema and improve neuronal functioning post-ICH, as with other injuries. We used the collagenase model of ICH to test whether bumetanide treatment for three days (vs. vehicle) would improve outcome. We gave bumetanide beginning at two hours or seven days post-ICH and measured behavioural outcome, edema, and brain ion content after treatment. There was some evidence for a minor reduction in edema after early dosing, but this did not improve behaviour or lessen injury. Contrary to our hypothesis, bumetanide did not normalize ion concentrations after late dosing. Bumetanide did not improve behavioural outcome or affect lesion volume. After ICH, bumetanide is safe to use in rats but does not improve functional outcome in the majority of animals.
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Affiliation(s)
| | - Brittany A. Fedor
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jasmine R. Aziz
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Colby A. Nadeau
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Paul S. Brar
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Julia J. A. Clark
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Frederick Colbourne
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
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