Epileptic manifestations in stroke patients treated with intravenous alteplase

Bentes, Carla; Martins, Hugo; Peralta, Ana Rita; Morgado, Carlos; Casimiro, Carlos; Franco, Ana Catarina; Fonseca, Ana Catarina; Geraldes, Ruth; Canhão, Patrı́cia; Melo, Teresa Pinho e; Paiva, Teresa; Ferro, José M.

doi:10.1111/ene.13292

Cited by 35 publications

(13 citation statements)

References 37 publications

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“…Our results support the findings of several smaller studies that did not find an increased number of acute symptomatic seizures in patients undergoing IVT 26,[28][29][30]32 . Some of these studies presented more clinical details of patients suffering from acute symptomatic seizures, but the overall numbers of patients with seizures were limited in most studies, ranging from n = 3 to n = 25.…”

Section: Discussionsupporting

confidence: 92%

“…These discrepancies are probably due to differences in seizure detection, classification and a referral bias in single-center studies with populations from tertiary stroke-centers. While it is known that standard electroencephalographic measurements significantly increase the likelihood of detecting post-stroke seizures 35 , only one study employed routine use of electroencephalography 28 . However, this prospective study did not report an overall seizure frequency 28 .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a number of publications have suggested that recanalization attempts after ischemic stroke with either IVT or MT could increase the risk of acute symptomatic seizures or subsequent epilepsy [23][24][25] . However, the data supporting this notion are from studies in which a limited number of patients suffered from acute seizures, and other reports could not show a correlation between recanalization of an arterial cerebral vessel and the occurrence of acute symptomatic seizures [26][27][28][29][30] . In addition, the vast majority of these studies only investigated IVT therapy, reporting a risk for acute symptomatic seizures after rt-PA treatment between 1-4%.…”

Section: Scientific Reportsmentioning

confidence: 96%

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Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke

Zöllner

Misselwitz

Mauroschat

et al. 2020

Sci Rep

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Recent data have suggested that performing recanalizing therapies in ischemic stroke might lead to an increased risk of acute symptomatic seizures. This applies to both intravenous thrombolysis and mechanical thrombectomy. We therefore determined the frequency of acute symptomatic seizures attributable to these two recanalization therapies using a large, population-based stroke registry in Central Europe. We performed two matched 1:1 case–control analyses. In both analyses, patients were matched for age, stroke severity on admission and pre-stroke functional status. The first analysis compared patients treated with intravenous thrombolysis to a non-recanalization control group. To isolate the effect of mechanical thrombectomy, we compared patients with both mechanical thrombectomy and intravenous thrombolysis to those with only intravenous thrombolysis treatment in a second analysis. From 135,117 patients in the database, 13,356 patients treated with only intravenous thrombolysis, and 1013 patients treated with both intravenous thrombolysis and mechanical thrombectomy were each matched to an equivalent number of controls. Patients with intravenous thrombolysis did not suffer from clinically apparent acute symptomatic seizures significantly more often than non-recanalized patients (treatment = 199; 1.5% vs. control = 237; 1.8%, p = 0.07). Mechanical thrombectomy in addition to intravenous thrombolysis also was not associated with an increased risk of acute symptomatic seizures, as the same number of patients suffered from seizures in the treatment and control group (both n = 17; 1.7%, p = 1). In a large population-based stroke registry, the frequency of clinically apparent acute symptomatic seizures was not increased in patients who received either intravenous thrombolysis alone or in conjunction with mechanical thrombectomy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Scientific Reportsmentioning

confidence: 96%

See 1 more Smart Citation

Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke

Zöllner

Misselwitz

Mauroschat

et al. 2020

Sci Rep

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show abstract

“…In particular, intravenous thrombolysis was associated with a threefold higher risk of stroke-related seizures. In contrast, Bentes et al [40] and Tan et al [41] did not reveal any correlation between thrombolysis in the acute stage of stroke and a higher risk of late seizures. Moreover, Nesselroth et al [42] showed that thrombolysis treatment significantly decreased the risk of poststroke epilepsy.…”

Section: Predictors Related To Treatmentmentioning

confidence: 85%

Multifactorial Predictors of Late Epileptic Seizures Related to Stroke: Evaluation of the Current Possibilities of Stratification Based on Existing Prognostic Models—A Comprehensive Review

Wiśniewski

Jatužis

2021

IJERPH

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Background: Epilepsy associated with strokes is a significant clinical and public health problem and has a negative impact on prognosis and clinical outcome. A late epileptic seizure occurring seven days after stroke is actually equated with poststroke epilepsy due to the high risk of recurrence. Predictive models evaluated in the acute phase of stroke would allow for the stratification and early selection of patients at higher risk of developing late seizures. Methods: The most relevant papers in this field were reviewed to establish multifactorial predictors of late seizures and attempt to standardize and unify them into a common prognostic model. Results: Clinical and radiological factors have become the most valuable and reproducible predictors in many reports, while data on electroencephalographic, genetic, and blood biomarkers were limited. The existing prognostic models, CAVE and SeLECT, based on relevant, readily available, and routinely assessed predictors, should be validated and improved in multicenter studies for widespread use in stroke units. Conclusions: Due to contradictory reports, a common and reliable model covering all factors is currently not available. Further research might refine forecasting models by incorporating advanced radiological neuroimaging or quantitative electroencephalographic analysis.

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“…Thrombolysis with recombinant tissue plasminogen activator (tPA) is the standard of care for all acute ischemic stroke meeting inclusion criteria, therefore it is important to note that there has been some evidence suggesting an increased risk of post-stroke seizures with the use of tPA [64][65]. However, other studies that did not find a statistically significant difference with regard to increased post-tPA seizure incidence [66][67]. Statins, which are widely used in stroke and cardiac patients for lipid control, on the other hand have been shown to be beneficial against post-stroke seizures [68][69].…”

Section: Management Of Post-stroke Seizuresmentioning

confidence: 99%

Incidence, Implications, and Management of Seizures Following Ischemic and Hemorrhagic Stroke

Doria

Forgács

2019

Curr Neurol Neurosci Rep

115

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Purpose of review: In this review we summarize the recent literature regarding incidence and treatment of seizures arising after ischemic and hemorrhagic strokes. Additionally, we identify open questions in guidelines and standard clinical care to aid future studies aim to improve management of seizures in post-stroke patients. Recent findings: Studies demonstrate an increasing prevalence of seizures following strokes, probably a consequence of advances in post-stroke management and expanding use of continuous EEG monitoring. Post-stroke seizures are associated with longer hospitalization and increased mortality; therefore, prevention and timely treatment of seizures is important. The standard of care is to treat recurrent seizures with anti-epileptic drugs (AEDs) regardless of the etiology. However, there are no established guidelines currently for prophylactic use of AEDs following a stroke.

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Epileptic manifestations in stroke patients treated with intravenous alteplase

Abstract: Intravenous alteplase is not associated with an increased risk of clinical or electroencephalographic epileptic phenomena.

Cited by 35 publications

References 37 publications

Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke

Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke

Multifactorial Predictors of Late Epileptic Seizures Related to Stroke: Evaluation of the Current Possibilities of Stratification Based on Existing Prognostic Models—A Comprehensive Review

Incidence, Implications, and Management of Seizures Following Ischemic and Hemorrhagic Stroke

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