Impact of Seizure Recurrence on 1-Year Functional Outcome and Mortality in Patients With Poststroke Epilepsy

Yoshimura, Hajime; Fukuma, Kazuki; Matsubara, Soichiro; Motoyama, Rie; Mizobuchi, Masahiro; Matsuki, Takayuki; Manabe, Yasuhiro; Suzuki, Junichiro; Kobayashi, Katsuya; Shimotake, Akihiro; Nishimura, Kunihiro; Onozuka, Daisuke; Kawamoto, Manabu; Koga, Masatoshi; Toyoda, Kazunori; Murayama, Shigeo; Matsumoto, Riki; Takahashi, Ryōsuke; Ito, Akio; Ihara, Masafumi

doi:10.1212/wnl.0000000000200609

Cited by 14 publications

(15 citation statements)

References 44 publications

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“…Post-stroke seizures are associated with a worse functional outcome, a higher mortality rate and increased risk of comorbidities [4]. Many risk factors of PSSs (cortical involvement, haemorrhagic transformation, intracerebral haemorrhage [5] and baseline stroke severity [6]) have been identified; however, the role of endovascular treatment (EVT) for PSSs is controversial.…”

Section: Introductionmentioning

confidence: 99%

Incidence and association of seizures in stroke patients following endovascular treatment: A systematic review and meta‐analysis

Liu

Deng

et al. 2022

Euro J of Neurology

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Background and purpose: Post-stroke seizures (PSSs) are some of the most common complications of stroke and are associated with poor outcomes in patients. Endovascular treatment (EVT) is the standard of care for patients with acute ischaemic stroke related large-vessel occlusion. However, whether EVT increases the risk of PSSs remains controversial; the association between PSSs and EVT is poorly understood.Methods: PubMed, Embase and the Cochrane Library were searched for relevant studies published from 1995 to 6 December 2021. The overall incidence of PSSs in patients treated with EVT and the separate incidence for all included studies in each subgroup, stratified by the type of treatment or time of onset, were calculated. The pooled odds ratio and confidence interval were calculated to quantify the effects of EVT on PSS occurrence.Results: In all, 946 studies were screened and 16 articles were included, with a total sample size of 12,664 patients; 7836 patients received EVT, of whom 460 had PSS. The pooled incidence of PSS after EVT was 5.8%, which was similar to patients treated with mechanical thrombectomy (5.3%), intra-arterial thrombolysis (6.8%) or bridging therapy (5.4%). The cumulative incidence of post-stroke epilepsy (6.0%) was almost twice that of acute symptomatic seizures (3.6%). The pooled odds ratio for the relationship between EVT and PSS was 1.91 (95% confidence interval 0.98-3.73). Conclusions:The cumulative incidence of stroke patients treated with EVT who developed seizures was 5.8%, and EVT was non-significantly associated with the occurrence of seizures after stroke.

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Section: Introductionmentioning

confidence: 99%

Incidence and association of seizures in stroke patients following endovascular treatment: A systematic review and meta‐analysis

Liu

Deng

et al. 2022

Euro J of Neurology

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“… 6 , 7 Previous studies have demonstrated that the presence of PSE was associated with neurological worsening, 8 changing the modified Rankin scale (mRS) from 3 to 4, 9 and functional decline. 10 Another study reported that health-related quality of life score was reduced in patients with PSE, and seizure frequency was an independent determinant of health-related quality of life score in patients with PSE. 11 Furthermore, patients with PSE have a higher risk of short- and long-term mortality within 30-day and 20-year post seizures, respectively.…”

Section: Introductionmentioning

confidence: 99%

Interictal epileptiform discharges as a predictive biomarker for recurrence of poststroke epilepsy

Abe

Fukuma

Matsubara

et al. 2022

Brain Communications

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Poststroke epilepsy is a major ischemic/hemorrhagic stroke complication. Seizure recurrence risk estimation and early therapeutic intervention are critical given the association of poststroke epilepsy with worse functional outcomes, quality of life, and greater mortality. Several studies have reported risk factors for seizure recurrence; however, in poststroke epilepsy, the role of EEG in predicting the risk of seizures remains unclear. This multicenter observational study aimed to clarify whether EEG findings constitute a risk factor for seizure recurrence in patients with poststroke epilepsy. Patients with poststroke epilepsy were recruited from the Prognosis of Post-Stroke Epilepsy study, an observational multicenter cohort study. The enrolled patients with poststroke epilepsy were those admitted at selected hospitals between November 2014 and June 2017. All patients underwent EEG during the interictal period during admission to each hospital and were monitored for seizure recurrence over 1 year. Board-certified neurologists or epileptologists evaluated all EEG findings. We investigated the relationship between EEG findings and seizure recurrence. Among 187 patients with poststroke epilepsy (65 were women with a median age of 75 years) admitted to the lead hospital, 48 (25.7%) had interictal epileptiform discharges on EEG. During the follow-up period (median, 397 days; interquartile range, 337–450 days), interictal epileptiform discharges were positively correlated with seizure recurrence (hazard ratio, 3.82; 95% confidence interval, 2.09–6.97], p < 0.01). The correlation remained significant even after adjusting for age, sex, severity of stroke, type of stroke, and generation of antiseizure medications. We detected periodic discharges in 39 patients (20.9%), and spiky/sharp periodic discharges were marginally associated with seizure recurrence (hazard ratio, 1.85; 95% confidence interval, 0.93–3.69; p = 0.08). Analysis of a validation cohort comprising 187 patients with poststroke epilepsy from seven other hospitals corroborated the association between interictal epileptiform discharges and seizure recurrence. We verified that interictal epileptiform discharges are a risk factor for seizure recurrence in patients with poststroke epilepsy. Routine EEG may facilitate the estimation of seizure recurrence risk and the development of therapeutic regimens for poststroke epilepsy.

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“…Patients with PSE are more likely to have neurological sequelae due to stroke or aging‐related comorbidities than those with other focal epilepsies, 2 and additional postseizure functional decline may have a significant effect. Our recent study demonstrated that 11.8% of patients with PSE and first‐ever seizures had a long‐term functional decline 1 year after discharge 3 . However, data on electroencephalogram (EEG) markers associated with postseizure short‐term or long‐term functional decline in PSE are scarce.…”

Section: Introductionmentioning

confidence: 99%

Periodic discharges plus fast activity on electroencephalogram predict worse outcomes in poststroke epilepsy

Fukuma,

Tojima,

Tanaka

et al. 2023

Epilepsia

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ObjectivesPost‐seizure functional decline is a concern in post‐stroke epilepsy (PSE). However, data on electroencephalogram (EEG) markers associated with functional decline are scarce. Thus, we investigated whether periodic discharges (PDs) and their specific characteristics are associated with functional decline in patients with PSE.MethodsIn this observational study, patients admitted with seizures of PSE and who had scalp EEGs were included. The association between the presence or absence of PDs and post‐seizure short‐term functional decline lasting 7 days after admission was investigated. In patients with PD, EEG markers were explored for risk stratification of short‐term functional decline, according to the American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology. The association between EEG markers and imaging findings and long‐term functional decline at discharge and 6 months after discharge, defined as an increase in the modified Rankin Scale score compared with the baseline, was evaluated.ResultsIn this study, 307 patients with PSE (median age, 75; range, 35–97 years; 64% males; hemorrhagic stroke, 47%) were enrolled. Compared with 247 patients without PDs, 60 patients with PDs were more likely to have short‐term functional decline (12 (20%) vs. 8 (3.2%), p < 0.001), with an adjusted odds ratio (OR) of 4.26 (95% confidence interval (CI), 1.44–12.6; p = 0.009). Patients with superimposed fast‐activity PDs (PDs+F) had significantly more localized (rather than widespread) lesions (87% vs. 58%, p = 0.003), prolonged hyperperfusion (100% vs. 62%, p = 0.023), and a significantly higher risk of short‐term functional decline than those with PDs without fast activity (adjusted OR, 22.0; 95% CI, 1.87–259.4; p = 0.014). Six months after discharge, PDs+F were significantly associated with long‐term functional decline (adjusted OR, 4.21; 95% CI, 1.27–13.88; p = 0.018).SignificanceIn PSE, PDs+F are associated with sustained neuronal excitation and hyperperfusion, which may be a predictor of post‐seizure short‐ and long‐term functional decline.

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Impact of Seizure Recurrence on 1-Year Functional Outcome and Mortality in Patients With Poststroke Epilepsy

Cited by 14 publications

References 44 publications

Incidence and association of seizures in stroke patients following endovascular treatment: A systematic review and meta‐analysis

Incidence and association of seizures in stroke patients following endovascular treatment: A systematic review and meta‐analysis

Interictal epileptiform discharges as a predictive biomarker for recurrence of poststroke epilepsy

Periodic discharges plus fast activity on electroencephalogram predict worse outcomes in poststroke epilepsy

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