Effect of Reperfusion Therapies on Incidence of Early Post-Stroke Seizures

Abstract

Objective: This study aimed to determine the effect of reperfusion therapies on the occurrence of early post-stroke seizures (PSS) in patients with acute ischemic stroke (AIS).Background: Reperfusion therapies are paramount to the treatment of stroke in the acute phase. However, their effect on the incidence of early seizures after an AIS remains unclear.Design and Methods: The stroke database at Hamad Medical Corporation was used to identify all patients who received reperfusion therapies for AIS from 2016 to 2019. They were matched with patients of similar diagnosis, gender, age, and stroke severity as measured by National Institutes of Health Stroke Scale (NIHSS) who did not receive such treatment. The rates of early PSS were calculated for each group.Results: The results showed that 508 patients received reperfusion therapies (342 had IV thrombolysis only, 70 had thrombectomies only, and 96 had received both), compared with 501 matched patients receiving standard stroke unit care. Patients who received reperfusion therapies were similar to their matched controls for mean admission NIHSS score (9.87 vs. 9.79; p = 0.831), mean age (53.3 vs. 53.2 years; p = 0.849), and gender distribution (85 vs. 86% men; p = 0.655). The group receiving reperfusion therapies was found to have increased stroke cortical involvement (62 vs. 49.3%, p < 0.001) and hemorrhagic transformation rates (33.5 vs. 18.6%, p < 0.001) compared with the control group. The rate of early PSS was significantly lower in patients who received reperfusion therapies compared with those who did not (3.1 vs. 5.8%, respectively; p = 0.042). When we excluded seizures occurring at stroke onset prior to any potential treatment implementation, the difference in early PSS rates between the two groups was no longer significant (2.6 vs. 3.9%, respectively; p = 0.251). There was no significant difference in early PSS rate based on the type of reperfusion therapy either (3.2% with thrombolysis, 2.9% with thrombectomy, and 3.1% for the combined treatment, p = 0.309).Conclusions: Treatment of AIS with either thrombectomy, thrombolysis, or both does not increase the risk of early PSS.

Outcomes in Patients With Poststroke Seizures

“…Our search yielded 71 studies (Figure 1). There was 1 ambispective, 20 prospective, 47 retrospective cohort studies, and 3 case-control studies. All studies were published in English, and we identified no studies in other languages.…”

“…The articles included 1967 patients (9.8%) with early seizures and 10 605 patients (52.7%) with late seizures after stroke; 7538 seizures (37.5%) were not classified as early or late. PSS were diagnosed according to clinical or medical chart data in 59 studies and using the ICD-10 codes in 12 studies (including 15 033 patients [74.8%]). Patients with PSS had a significantly higher history of ischemic heart disease (OR, 1.3; 95% CI, 1.1-1.6), prior cerebrovascular disease (OR, 1.3; 95% CI, 1.0-1.6), atrial fibrillation (OR, 1.2; 95% CI, 1.1-1.4), and the presence of hemorrhagic transformation (OR, 2.2; 95% CI, 1.6-3.0) than patients without PSS (eTable 3 in Supplement 1).…”

“…Five studies (7.0%) had a high risk of bias, 35 studies (49.3%) presented a moderate risk of bias, and 31 studies (43.7%) had a low risk of bias (eTable 4 in Supplement 1).…”

Poststroke Seizure and Epilepsy: A Review of Incidence, Risk Factors, Diagnosis, Pathophysiology, and Pharmacological Therapies

“…(5) Reperfusion Therapy . The risk of PSE increases with ineffective systemic thrombolysis, resulting in large and diffuse cerebral infarcts with hemorrhagic components [ 21 ]. In patients with PSE who had undergone systemic thrombosis, aphasia was the most often diagnosed symptom due to the infarct being more often located in the left hemisphere in patients with PSE.…”

“…Moreover, in patients with PSE receiving systemic thrombolysis, there seems to be a hemorrhagic component in the deep and terminal branches of the middle cerebral artery, which has been attributed to causing greater permeability of the blood-brain barrier in PSE. In patients who have undergone systemic thrombolysis, the hemorrhagic component may have contributed to the PSE by acting as a neurotoxin in the cerebral cortex, activating matrix metalloproteinases, losing inhibitory neurons, and increasing the synthesis of nitric oxide [ 21 , 22 ].…”