Hospital Revisits for Post-Ischemic Stroke Epilepsy after Acute Stroke Interventions

Kuohn, Lindsey; Herman, Alison L; Soto, Alexandria; Brown, Stacy; Gilmore, Emily J.; Hirsch, Lawrence J.; Matouk, Charles; Sheth, Kevin N; Kim, Jennifer A

doi:10.1016/j.jstrokecerebrovasdis.2021.106155

Cited by 5 publications

(1 citation statement)

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“…Our systematic review identified that 15 033 patients with PSS (74.8%) from 12 studies were diagnosed using ICD-10 codes. ICD-10 code–based research is prone to misclassification and may lead to errors in hospital admissions . However, when we stratified the data based on ICD-10 and no ICD-10 codes, the results were consistent for studies with no ICD-10 codes (Table 1, Table 2, and eTables 5 and 6 in Supplement 1).…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Patients With Poststroke Seizures

Misra,

Kasner,

Dawson

et al. 2023

JAMA Neurol

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ImportancePublished data about the impact of poststroke seizures (PSSs) on the outcomes of patients with stroke are inconsistent and have not been systematically evaluated, to the authors’ knowledge.ObjectiveTo investigate outcomes in people with PSS compared with people without PSS.Data SourcesMEDLINE, Embase, PsycInfo, Cochrane, LILACS, LIPECS, and Web of Science, with years searched from 1951 to January 30, 2023.Study SelectionObservational studies that reported PSS outcomes.Data Extraction and SynthesisThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for abstracting data, and the Joanna Briggs Institute tool was used for risk-of-bias assessment. Data were reported as odds ratio (OR) and standardized mean difference (SMD) with a 95% CI using a random-effects meta-analysis. Publication bias was assessed using funnel plots and the Egger test. Outlier and meta-regression analyses were performed to explore the source of heterogeneity. Data were analyzed from November 2022 to January 2023.Main Outcomes and MeasuresMeasured outcomes were mortality, poor functional outcome (modified Rankin scale [mRS] score 3-6), disability (mean mRS score), recurrent stroke, and dementia at patient follow-up.ResultsThe search yielded 71 eligible articles, including 20 110 patients with PSS and 1 166 085 patients without PSS. Of the participants with PSS, 1967 (9.8%) had early seizures, and 10 605 (52.7%) had late seizures. The risk of bias was high in 5 studies (7.0%), moderate in 35 (49.3%), and low in 31 (43.7%). PSSs were associated with mortality risk (OR, 2.1; 95% CI, 1.8-2.4), poor functional outcome (OR, 2.2; 95% CI, 1.8-2.8), greater disability (SMD, 0.6; 95% CI, 0.4-0.7), and increased dementia risk (OR, 3.1; 95% CI, 1.3-7.7) compared with patients without PSS. In subgroup analyses, early seizures but not late seizures were associated with mortality (OR, 2.4; 95% CI, 1.9-2.9 vs OR, 1.2; 95% CI, 0.8-2.0) and both ischemic and hemorrhagic stroke subtypes were associated with mortality (OR, 2.2; 95% CI, 1.8-2.7 vs OR, 1.4; 95% CI, 1.0-1.8). In addition, early and late seizures (OR, 2.4; 95% CI, 1.6-3.4 vs OR, 2.7; 95% CI, 1.8-4.1) and stroke subtypes were associated with poor outcomes (OR, 2.6; 95% CI, 1.9-3.7 vs OR, 1.9; 95% CI, 1.0-3.6).Conclusions and RelevanceResults of this systematic review and meta-analysis suggest that PSSs were associated with significantly increased mortality and severe disability in patients with history of stroke. Unraveling these associations is a high clinical and research priority. Trials of interventions to prevent seizures may be warranted.

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Section: Discussionmentioning

confidence: 99%