Early seizures after ischemic stroke: focus on thrombolysis

Abstract

Introduction.Stroke is a significant underlying cause of epilepsy. Seizures due to ischemic stroke (IS) are generally categorized into early seizures (ESs) and late seizures (LSs). Seizures in thrombolysis situations may raise the possibility of other etiology than IS.Aim.We overtook a systematic review focusing on the pathogenesis, prevalence, risk factors, detection, management, and clinical outcome of ESs in IS and in stroke/thrombolysis situations. We also collected articles focusing on the association of recombinant tissue-type plasminogen activator (rt-PA) treatment and epileptic seizures.Results.We have identified 37 studies with 36,775 participants. ES rate was 3.8% overall in patients with IS with geographical differences. Cortical involvement, severe stroke, hemorrhagic transformation, age (<65 years), large lesion, and atrial fibrillation were the most important risk factors. Sixty-one percent of ESs were partial and 39% were general. Status epilepticus (SE) occurred in 16.3%. 73.6% had an onset within 24 h and 40% may present at the onset of stroke syndrome. Based on EEG findings seizure-like activity could be detected only in approximately 18% of ES patients. MRI diffusion-weighted imaging and multimodal brain imaging may help in the differentiation of ischemia vs. seizure. There are no specific recommendations with regard to the treatment of ES.Conclusion.ESs are rare complications of acute stroke with substantial burden. A significant proportion can be presented at the onset of stroke requiring an extensive diagnostic workup.

Acute symptomatic seizures and epilepsy after mechanical thrombectomy

“…In our study, 4/90 patients (4.4%) developed acute symptomatic seizures. This is similar to previously reported rates for patients treated with intravenous thrombolytics without thrombectomy [7,8], but reports range from 1% to 15 % [6,9]. So far, described risks of acute symptomatic seizures or PSE after thrombectomy are relatively lowgiven that patients selected for therapy are often at risk of very large lesions.…”

“…Reported rates of acute symptomatic seizures (seizures within one week of stroke) in thrombolysis-treated patients vary from approximately 1% to 15% [6][7][8][9]. In three relatively recent studies of thrombolysis-treated cohorts, PSE (seizures occurring >1 week after stroke) was reported in 5.8%-16.7% [6,10,11].…”

Post Stroke Seizures and Epilepsy: From Proteases to Maladaptive Plasticity

“…For example, specific stroke types, such as hemorrhagic stroke and total anterior circulation stroke are strongly correlated with increased chance of PSE (Leone et al, 2009; Graham et al, 2013). ES, with an overall prevalence of 3.8% (Feher et al, 2019), is also correlated with similar stroke groups, being more common after hemorrhagic (8.4%) compared to ischemic stroke (2.4%) (Szaflarski et al, 2008). The extent of cortical injury is also considered to be an important issue for both ES and LS, as studies have shown that the involvement of the parietotemporal cortex, supramarginal gyrus and superior temporal gyrus seems to be connected to post stroke epileptogenesis (Zhao et al, 2018).…”

Assessment of the incidence and risk factors of early poststroke seizures in Lebanese patients

“…The presumed pathophysiology explaining the emergence of early seizures by ischemic strokes is linked to the transient cellular biochemical dysfunctions in the brain tissue that occur following acute ischemia (Feher et al., 2020 ) A lower threshold for depolarization from local excitotoxicity secondary to increased glutamate along with an increased intracellular calcium and sodium inflow results in lowering the seizure threshold for depolarization and leading to electrically irritable tissue with consequent hyperexcitability and possible neuronal injury (Camilo & Goldstein, 2004 ).…”