Seizures after Ischemic Stroke: A Matched Multicenter Study

Accidente cerebrovascular isquémico; Tratamiento de reperfusión; Factores de riesgoIschemic Stroke; Reperfusion treatment; Risk factorsAccident cerebrovascular isquèmic; Tractament de reperfusió; Factor de riscObjective The purpose of this study was to identify risk factors for acute symptomatic seizures and post-stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. Methods We assessed the risk factors for post-stroke seizures using logistic or Cox regression in a multicenter study, including adults from 8 European referral centers with neuroimaging-confirmed ischemic stroke. We compared the risk of post-stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. Results In the overall cohort of 4,229 participants (mean age 71 years, 57% men), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and strokes caused by large-artery atherosclerosis. Strokes caused by small-vessel occlusion carried a small risk of acute symptomatic seizures. 6% developed post-stroke epilepsy. Risk factors for post-stroke epilepsy were acute symptomatic seizures, more severe strokes, infarcts involving the cerebral cortex, and strokes caused by large-artery atherosclerosis. Electroencephalography findings within 7 days of stroke onset were not independently associated with the risk of post-stroke epilepsy. There was no association between reperfusion treatments in general or only intravenous thrombolysis or mechanical thrombectomy with the time to post-stroke epilepsy or the risk of acute symptomatic seizures. Interpretation Post-stroke seizures are related to stroke severity, etiology, and location, whereas an early electroencephalogram was not predictive of epilepsy. We did not find an association of reperfusion treatment with risks of acute symptomatic seizures or post-stroke epilepsy

Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model

IMPORTANCE: Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. OBJECTIVE: To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. EXPOSURES: Type of acute symptomatic seizure. MAIN OUTCOMES AND MEASURES: All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). RESULTS: A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. CONCLUSIONS AND RELEVANCE: In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up

Correlation between stroke and development of poststroke seizures and epilepsy

Der Schlaganfall ist im höheren Lebensalter eine der häufigsten Ursachen für symptomatische Epilepsien. Aufgrund der demographischen Entwicklung mit zunehmend höherer Lebenserwartung stellen postischämische epileptische Anfälle ein immer grösseres Gesundheitsproblem dar und sind in der neurologischen Praxis ein immer häufiger zu beobachtendes Phänomen. Mit dieser Arbeit sollen Risikofaktoren für die Entwicklung vaskulär bedingter epileptischer Anfälle herausgearbeitet werden, um Patienten mit erhöhtem Risiko zeitig zu erkennen und gegebenenfalls bereits nach dem ersten epileptischen Anfall antikonvulsiv zu behandeln. Die publizierte Inzidenz postischämischer epileptischer Anfälle respektive Epilepsien variiert in der Literatur der letzten 30 Jahre stark. Diese Spannbreite ist auf unterschiedliche Studiendesigns, heterogenes Patientenkollektiv, inkonsistenten Gebrauch der Terminologien, variierende Fallzahlen und unterschiedlich lange Verlaufsperioden zurück zu führen. In der vorliegenden Arbeit konnte gezeigt werden, dass die Inzidenz postischämischer Anfälle mit 5.18% im Vergleich zu den in der Literatur publizierten Daten eher niedrig ist. Von den 5.18% waren 2.18% einmalige epileptische Anfälle und 3.0% rezidivierende Anfälle. Die niedrigere Inzidenz ist auf die strengen Ausschlusskriterien (insbesondere der Ausschluss einer primärer Hämorrhagien, aber auch der hämorrhagischen Transformation, metabolischer Störungen und Alkoholabhängigkeit) sowie auf ein heterogenes Patientenkollektiv mit Einschluss sowohl leichter als auch schwerer Schlaganfälle zurückzuführen und spiegelt wahrscheinlich eher die Inzidenz epileptischer Anfälle nach rein ischämischen Hirninfarkten wieder als die zuvor publizierten Daten. Zusammenfassend kann aufgrund der Resultate unserer Studie festgestellt werden, dass Patienten mit einem mikroangiopathischen, lakunären Infarkt tendentiell seltener epileptische Anfälle entwickeln und dass nach einer transitorisch ischämischen Attacke ein signifikant geringeres Risiko besteht einen epileptischen Anfall zu erleiden. Das Risiko für vaskulär bedingte epileptische Anfälle ist bei grossen Ischämien mit kortikaler Beteiligung signifikant erhöht. Bei Infarkten im Stromgebiet der Arteria cerebri media sowie bei schwerem neurologischem Defizit (major stroke) findet sich lediglich eine Tendenz zu häufigerem Auftreten von epileptischen Anfällen. Es konnte kein signifikanter Unterschied zwischen Frühanfällen und Spätanfällen bezüglich Entwicklung rezidivierender Anfälle gefunden werden; dies ist möglicherweise auf die kleinen Fallzahlen in den Untergruppen zurückzuführen. Bezugnehmend auf die bisher in der Lieratur publizierten Daten kann aufgrund widersprüchlicher Resultate immer noch keine defintive Aussage getroffen werden, welche Patienten nach einer zerebralen Durchblutungsstörung gefährdet sind rezidivierende postischämische Anfälle zu entwickeln, und wann der Beginn einer antikonvulsiven Therapie sinnvoll ist. Zukünftig braucht es prospektive, randomisierte, plazebokontrollierte Studien, welche das Outcome und das Rezidivrisiko für epileptische Anfälle nach ischämischem Hirninfarkt nach erstem Früh- respektive Spätanfall untersuchen.Stroke is the leading cause of epilepsy after the age of 60. The published incidence of post-stroke seizures and epilepsy varies from 4.4 to 42.8% according to different study designs. Methods: Our semi-prospective study included 599 first-ever stroke cases admitted to our hospital between January 2002 and December 2004. Patients with a prior history of stroke, epilepsy, haemorrhagic stroke or other possible causes of epilepsy (e.g. brain tumour, alcohol dependence) were excluded from the study.The follow-up period to identify stroke-related seizures was of a minimum of 36 months, in average 49.5 months. Poststroke epilepsy was related to clinical factors (age, sex, onset stroke severity, lesion size, localisation, stroke subtype and stroke- risk factor profile) and divided into “early onset” and “late onset” seizures occurring either within 7 days or more than one week after stroke, respectively. Results: Of all patients, 5.18% developed seizures after stroke, of whom 2.18% experienced a single epileptic seizure and 3.0% developed epilepsy with recurrent seizures. Early-onset seizures were detected in 25.8% and late-onset seizures in 74.2%. Predictors for developing vascular epilepsy are severity of initial neurological impairment, large lesions with cortical involvement and anterior circulation syndrome. No significant differences were observed in clinical predictors between early- and late-onset seizures, neither in single seizure nor in epilepsy. But a larger number of patients with late-onset seizures developed epilepsy. Conclusion: We found a rather low incidence of 5.18% of post-stroke seizures, which may be due to our strict exclusion criteria for potential epileptogenic pre-morbidities. In other studies this may be overestimated. As others, we also found more severe neurological impairment, large lesions with cortical involvement and anterior circulation syndrome to be predictive factors for post-stroke seizures

Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model

Importance: Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. Objective: To compare mortality and risk of epilepsy following different types of acute symptomatic seizures.Design, Setting, and ParticipantsThis cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. Exposures: Type of acute symptomatic seizure.Main Outcomes and MeasuresAll-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). Results: A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. Conclusions and Relevance: In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up

Seizures after ischemic stroke: a matched multicenter study

Objective: To identify risk factors for acute symptomatic seizures and post-stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. Methods: We assessed the risk factors for post-stroke seizures using logistic or Cox regression in a multicenter study including adults from eight European referral centers with neuroimaging-confirmed ischemic stroke. We compared the risk of post-stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. Results: In the overall cohort of 4229 participants (mean age 71 years, 57% male), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and strokes caused by large-artery atherosclerosis. Strokes caused by small-vessel occlusion carried a small risk of acute symptomatic seizures. The 6% developed post-stroke epilepsy. Risk factors for post-stroke epilepsy were acute symptomatic seizures, more severe strokes, infracts involving the cerebral cortex, and strokes caused by large-artery atherosclerosis. Electroencephalography findings within 7 days of stroke onset were not independently associated with the risk of post-stroke epilepsy. There was no association between reperfusion treatments in general or only intravenous thrombolysis or mechanical thrombectomy with the time to post-stroke epilepsy or the risk of acute symptomatic seizures. Interpretation: Post-stroke seizures are related to stroke severity, etiology, and location, whereas an early electroencephalogram was not predictive of epilepsy. We did not find an association of reperfusion treatment with risks of acute symptomatic seizures or post-stroke epilepsy. This article is protected by copyright. All rights reserved