Early seizures in patients with acute stroke: Frequency, predictive factors, and effect on clinical outcome

Barrios, V

doi:10.2147/vhrm.s2445

Cited by 67 publications

(17 citation statements)

References 32 publications

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“…In particular, a recent study conducted with the same prospective design and similar patient selection criteria, reporting data from stroke units and neurologic departments in Italy, found a 6.3% rate of ES, a figure slightly higher than our estimates [20]. Since stroke complications were not recorded in that analysis, as in others [21,22,23,24,25,26,27,28,29], however, we cannot rule out the possibility that such discrepancies might depend on different rates of complications among the studies.…”

Section: Discussioncontrasting

confidence: 48%

Complications of Acute Stroke and the Occurrence of Early Seizures

et al. 2013

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Background: Seizures are common neurological consequences of stroke. Although a number of factors including stroke severity on admission, cortical involvement, and stroke subtype have been consistently associated with post-stroke seizures, the effect that medical and neurological complications of stroke, occurring in the very acute phase, might have on such a risk has never been adequately explored. In the present study we aimed at determining the extent to which complications within the first week of stroke influence the risk of early seizures (ES). Methods: Data of consecutive patients with first-ever acute stroke included in the Brescia Stroke Registry were analyzed. ES (≤7 days) were recorded and correlated with demographic data, disease characteristics, risk factors, and prespecified medical and neurological stroke complications in a multivariate path analysis model. Results: 516 patients with first-ever acute stroke were eligible for inclusion in the present study. Of them, 436 patients had ischemic stroke (IS) [64 (14.6%) with hemorrhagic transformation (HT)] and 80 had intracerebral hemorrhage (ICH). Twenty patients (3.9%) developed ES. Patients with ES had a higher burden of complications compared with those without (30 vs. 4.2%, for patients with >6 complications). Lesion type, stroke complications, and lesion site were directly related to the risk of seizure occurrence (OR, 0.24; 95% CI, 0.07-0.80 for IS vs. ICH; OR, 1.57; 95% CI, 1.21-2.01 for any increase of 1 in the number of complications; OR, 0.15; 95% CI, 0.04-0.56 for subcortical lesions vs. cortical lesions). Complications appeared also to mediate the indirect effect of lesion type on the occurrence of ES (OR, 0.75; 95% CI, 0.60-0.94). No significant difference on the risk of ES was observed when HT and ICH were compared. The total effect of lesion type was 0.25 × 0.75 = 0.18, corresponding to (1-0.18) = 82% lower risk of ES for IS as compared to ICH. Conclusion: Although major determinants of ES are nonmodifiable, preventable and treatable medical and neurologic complications within the first week of stroke increase the risk of ES and mediate the effect of established predictors on the propensity to post-stroke epilepsy. Future epidemiologic studies aimed at investigating post-stroke seizures should include precise information on these complications.

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Section: Discussioncontrasting

confidence: 48%

Complications of Acute Stroke and the Occurrence of Early Seizures

et al. 2013

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“…However, our results with the PT model demonstrated that early poststroke seizures were restricted primarily to large cortical lesions, whereas smaller photothrombotic lesions did not induce seizures. This observation supports previous clinical data in which the probability of early seizures was higher in patients with stroke with larger lesions 44,45 . The photothrombosis model differs in the extent and nature of vessel occlusion; however, more importantly, unlike other stroke models, it shows almost no ischemic penumbra due to intense necrotization.…”

Section: Discussionsupporting

confidence: 89%

Preclinical examination of early‐onset thalamic‐cortical seizures after hemispheric stroke

García‐Peña,

Ramos,

López

et al. 2023

Epilepsia

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ObjectiveIschemic stroke is one of the main causes of death and disability worldwide and currently has limited treatment options. Electroencephalography (EEG) signals are significantly affected in stroke patients during the acute stage. In this study, we preclinically characterized the brain electrical rhythms and seizure activity during the hyperacute and late acute phases in a hemispheric stroke model with no reperfusion.MethodsEEG signals and seizures were studied in a model of hemispheric infarction induced by permanent occlusion of the middle cerebral artery (pMCAO), which mimics the clinical condition of stroke patients with permanent ischemia. Electrical brain activity was also examined using a photothrombotic (PT) stroke model. In the PT model, we induced a similar (PT group‐1) or smaller (PT group‐2) cortical lesion than in the pMCAO model. For all models, we used a nonconsanguineous mouse strain that mimics human diversity and genetic variation.ResultsThe pMCAO hemispheric stroke model exhibited thalamic‐origin nonconvulsive seizures during the hyperacute stage that propagated to the thalamus and cortex. The seizures were also accompanied by progressive slowing of the EEG signal during the acute phase, with elevated delta/theta, delta/alpha, and delta/beta ratios. Cortical seizures were also confirmed in the PT stroke model of similar lesions as in the pMCAO model, but not in the PT model of smaller injuries.SignificanceIn the clinically relevant pMCAO model, poststroke seizures and EEG abnormalities were inferred from recordings of the contralateral hemisphere (noninfarcted hemisphere), emphasizing the reciprocity of interhemispheric connections and that injuries affecting one hemisphere had consequences for the other. Our results recapitulate many of the EEG signal hallmarks seen in stroke patients, thereby validating this specific mouse model for the examination of the mechanistic aspects of brain function and for the exploration of the reversion or suppression of EEG abnormalities in response to neuroprotective and anti‐epileptic therapies.

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“…The present study investigated the incidence and temporal profiles of seizures as well as imaging characteristics in patients with PSE using modern VLSM. The incidence of PSE within 90 days of stroke onset in our prospectively collected cohort with first‐ever ischemic stroke was 2.8%, which is lower than reported in previous work 1,3,5,14,15 . This discrepancy may be attributed to the fact that previous investigators evaluated PSE in patients with hemorrhagic as well as ischemic strokes with variable times of follow‐up 1,3,5,14 .…”

Section: Discussioncontrasting

confidence: 74%

“…1,3,5,14,15 This discrepancy may be attributed to the fact that previous investigators evaluated PSE in patients with hemorrhagic as well as ischemic strokes with vari-able times of follow-up. 1,3,5,14 Hemorrhagic stroke has a higher risk for PSE than ischemic stroke. All patients in our cohort had a follow-up of 90 days after stroke onset.…”

Section: Discussionmentioning

confidence: 99%

Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy

Winder

Bobinger

Seifert

et al. 2023

Journal of Neuroimaging

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Background and Purpose:The relationship between ischemic stroke site and occurrence of poststroke epilepsy (PSE) is incompletely understood. This study intended to evaluate incidence and temporal profiles of seizures and to correlate ischemic lesion sites with PSE using voxel-based lesion symptom mapping (VLSM). Methods:Patients with imaging-confirmed first-ever ischemic stroke without prior history of epilepsy were prospectively included. Demographic data, cardiovascular risk factors, and National Institute of Health Stroke Scale (NIHSS) scores were assessed. Data on seizures and modified Rankin scale scores were determined within a 90-day period after stroke onset. Ischemic lesion sites were correlated voxel wise with occurrence of PSE using nonparametric permutation test. Age-and sex-matched patients with first-ever ischemic strokes without PSE after 90 days served as controls for the VLSM analysis. Results:The stroke database contained 809 patients (mean age: 68.4 ± 14.2 years) with first-ever imaging-confirmed ischemic strokes without history of epilep. Incidence of PSE after 90-day follow-up was 2.8%. Five additional patients were admitted to the emergency department with a seizure after 90-day follow-up. Fifty percent of the seizures occurred in the acute phase after stroke. PSE patients had higher NIHSS scores and infarct volumes compared to controls without PSE (p < .05). PSE patients had infarcts predominantly involving the cerebral cortex. The hemisphere-specific VLSM analysis shows associations between PSE and damaged voxels in the left-hemispheric temporo-occipital transition zone. Conclusions:The data indicate that PSE occurs in a small proportion of patients with rather large ischemic strokes predominantly involving the cerebral cortex. Especially patients with ischemic lesions in the temporo-occipital cortex are vulnerable to develop PSE.

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Early seizures in patients with acute stroke: Frequency, predictive factors, and effect on clinical outcome

Cited by 67 publications

References 32 publications

Complications of Acute Stroke and the Occurrence of Early Seizures

Complications of Acute Stroke and the Occurrence of Early Seizures

Preclinical examination of early‐onset thalamic‐cortical seizures after hemispheric stroke

Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy

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