Continuous assessment of electrical epileptic activity in acute stroke

Carrera, Emmanuel; Michel, Patrik; Despland, P. A.; Maeder-Ingvar, Malin; Ruffieux, Christiane; Debatisse, D.; Ghika, Joseph; Devuyst, G.; Bogousslavsky, Julien

doi:10.1212/01.wnl.0000223361.90278.ca

Cited by 86 publications

(62 citation statements)

References 33 publications

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“…Categorical variables were compared with 2 and Fisher exact test as appropriate and continuous variables with Mann-Whitney test. Outcome was dichotomized into favorable (modified Rankin Scale 0 -2) and poor clinical outcome (modified Rankin Scale 3-6).…”

Section: Discussionmentioning

confidence: 99%

“…1 Continuous electroencephalographic recordings in the acute phase after stroke found focal epileptiform abnormalities even in up to 17% of the patients. 2 The time from stroke onset to the first seizure is known to be critical for development of epilepsy, although the time to distinguish early and late seizures varies from 24 hours to 2 weeks in different studies. Early seizures constitute a risk of 17% to 35% for later epilepsy and late seizures, a risk of 65% to 90%.…”

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confidence: 99%

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Adverse Effect of Early Epileptic Seizures in Patients Receiving Endovascular Therapy for Acute Stroke

Jung

Schindler

Findling

et al. 2012

Stroke

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Background and Purpose-The aim of this study was to analyze epileptic seizures and their impact on outcome in patients with stroke treated with endovascular therapy. Methods-From December 1992 to December 2010 we managed 805 patients with stroke with endovascular therapy.Epileptic seizures, bleeding complications, and 3-month outcomes were recorded prospectively. Outcomes of patients with early seizures (within 24 hours of stroke onset) and patients with late seizures (Ͼ24 hours after stroke) were compared with outcomes of seizure-free patients using uni-and multivariable statistics.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Adverse Effect of Early Epileptic Seizures in Patients Receiving Endovascular Therapy for Acute Stroke

Jung

Schindler

Findling

et al. 2012

Stroke

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“…4 In addition, electric epileptic activity can be expected in every sixth patient with acute stroke. 8 Thus, the clinical significance of additional studies to distinguish mimics from strokes before IVT is unclear.…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis in Stroke Mimics

Winkler

Fluri

Fuhr

et al. 2009

Stroke

168

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Background and Purpose— Intravenous thrombolysis for acute ischemic stroke is usually based on clinical assessment, blood test results, and CT findings. Intravenous thrombolysis of stroke mimics may occur but has not been studied in detail. Methods— We determined frequency, clinical characteristics, and outcome of mimic patients versus patients with stroke treated with intravenous thrombolysis using data of a prospective, single-center thrombolysis data bank. Results— Among 250 patients, 243 (97.2%) had strokes and 7 (2.8%) were mimics. Seizure was the most frequent diagnosis among mimics. There was a trend toward lower National Institutes of Health Stroke Scale scores in mimics (9.9±4.2) compared with strokes (13.7±5.4; P =0.06). Global aphasia without hemiparesis was the presenting symptom in 3 (42.9%) mimics versus 8 (3.3%) strokes ( P =0.002). Orolingual angioedema, symptomatic intracranial hemorrhage, and asymptomatic intracranial hemorrhage occurred in 3 (1.2%), 13 (5.3%), and 30 (12.3%) patients with stroke, but were absent in mimics. After 3 months, 6 (85.7%) mimics and 86 (35.4%) strokes had a modified Rankin Scale score of 0 to 1 ( P =0.01). Conclusions— Only few patients receiving intravenous thrombolysis did eventually have a final diagnosis other than stroke, ie, mostly seizures. Their outcome was favorable. Although clinical features differed between the stroke and the mimic groups, the differences were not distinctive enough to allow assigning individual patients to either of the groups. Multimodal neuroimaging or electroencephalographic recordings may be helpful for this assignment. However, their potential benefit has to be weighed against the potential harm of delayed thrombolysis.

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“…In fact, stroke-induced seizures are distinguished between those occurring in the acute phase of stroke and those occurring in the following months or even years. The different incidence rates found among studies are also due to the different timing used to define early seizures (ES), varying between 24 h [8,9,10], 2 weeks [11,12,13,14,15] and 4 weeks [16]. In most recent studies, however, the 7-day time frame has been used as it represents the time interval needed in order to define acute symptomatic seizures [17,18,19].…”

Section: Introductionmentioning

confidence: 99%

Are Early Seizures Predictive of Epilepsy after a Stroke? Results of a Population-Based Study

Serafini¹,

Gigli²,

Gregoraci³

et al. 2015

Neuroepidemiology

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Background: In addition to determining the cumulative incidence and risk factors for early seizures (ES), late seizures (LS) and post stroke epilepsy (PSE), we aimed at checking if ES represented a risk factor for epilepsy and if early treatment after ES prevented the occurrence of subsequent seizures. Methods: This study was part of a 2-year prospective community-based registry of all cerebrovascular events in the district of Udine (153,312 inhabitants), North-Eastern Italy, between April 1, 2007 and March 31, 2009. People with transient ischemic attacks (TIAs) were excluded from this study. Results: In all, 782 cases of stroke (79.28% ischemic, 14.83% hemorrhagic, 3.20% subarachnoid hemorrhage and 2.69% undetermined) were identified. The incidence of ES, LS and PSE was 5.10, 3.14 and 2.22%, respectively. Intracerebral hemorrhage, subarachnoid hemorrhage, stroke of undetermined origin and hyponatremia, represented risk factors for ES (p < 0.05). Among ischemic strokes, ES risk factors were hyponatremia (p = 0.024) and hemorrhagic transformation (p = 0.046). LS risk factors were younger age (p = 0.004) and cortical location of stroke (p = 0.004). Within ischemic strokes, LS risk factors were younger age (p = 0.020) and cortical location (p < 0.0001). Within intracerebral hemorrhages, the only risk factor for LS was the presence of a previous ES (p = 0.017). PSE risk factors were the same as for LS. Conclusions: All acute conditions related to the occurrence of stroke are implicated in the pathogenesis of ES, which becomes a risk factor for LS only in the setting of intracerebral hemorrhages. Therefore, early antiepileptic treatment is needed only in this situation.

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Continuous assessment of electrical epileptic activity in acute stroke

Abstract: In patients with acute stroke, electrical epileptic activity occurs more frequently than previously suspected.

Cited by 86 publications

References 33 publications

Adverse Effect of Early Epileptic Seizures in Patients Receiving Endovascular Therapy for Acute Stroke

Adverse Effect of Early Epileptic Seizures in Patients Receiving Endovascular Therapy for Acute Stroke

Thrombolysis in Stroke Mimics

Are Early Seizures Predictive of Epilepsy after a Stroke? Results of a Population-Based Study

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