In‐hospital costs in patients with seizures and epilepsy after stroke

Guekht, Alla; Mizinova, Maria; Ershov, Andrey; Guz, Denis; Kaimovsky, I.; Messina, Paolo; Beghi, Ettore

doi:10.1111/epi.13062

Cited by 12 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Encephalopathy has a negative impact in overall neurological recovery of cancer patients [21, 31]. Moreover, patients with NCS and status epilepticus are also known to have poor neurological recovery [5–8]. Therefore, our cohort population of cancer patients with ongoing moderate to severe encephalopathy, and with a significant prevalence of NCS and NCSE, could reflect on our findings of poor neurological recovery.…”

Section: Discussionmentioning

confidence: 93%

“…Electroencephalogram (EEG) monitoring is frequently used as part of the diagnostic work up of encephalopathic critically ill patients [5]. Patients diagnosed with seizures in the ICU usually have worse outcomes, including increased length of stay (LOS) and mortality, and increased ICU costs [5–8]. Moreover, they can have long-term medical consequences as more than 60% of patients diagnosed with NCS and NCSE have recurrent seizures after being discharged from the hospital [9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Non-convulsive seizures in the encephalopathic critically ill cancer patient does not necessarily portend a poor prognosis

et al. 2019

View full text Add to dashboard Cite

BackgroundNon-convulsive status epilepticus (NCSE) is present in 10–30% of ICU patients with altered mental status (AMS) and is associated to poor outcomes. To our knowledge, there is no data describing the prevalence and outcomes of critically ill cancer patients with AMS associated to non-convulsive seizures (NCS) or NCSE. We aim to describe the outcomes and risk factors of critically ill cancer patients with encephalopathy associated with non-convulsive seizures (NCS).MethodsThis is a 3-year prospective observational study in a mixed oncological ICU at MD Anderson Cancer Center. Data of ICU patients with moderate to severe encephalopathy (Glasgow Coma Score < 13) that underwent EEG monitoring to rule out NCS were collected. Multivariate logistic regression was performed to identify risk factors and outcomes.ResultsOf the 317 patients with encephalopathy who underwent EEG monitoring, 14.5% had NCS. Known risk factors such as sepsis, CNS infection, antibiotics, and cardiac arrest were not associated with increased risk of NCS. Patients with NCS were more likely to have received recent chemotherapy (41.3% vs 21.4%; p = 0.0036), have a CNS disease (39% vs 24.4%; p = 0.035), and abnormal brain imaging (60.9% vs 44.6%; p = 0.041). Patients with lower SOFA scores, normal renal function, and absence of shock were likely to have NCS as the cause of their encephalopathy (p < 0.03). After multivariate analysis, only abnormal brain imaging and absence of renal failure were associated with NCS. Mortality was significantly lower in patients with non-convulsive seizures when compared to those without seizures (45.7% vs 64%; p = 0.022); however, there was no significant association of seizures and mortality on a multivariable logistic regression analysis.ConclusionsNCS in critically ill cancer patients is associated with abnormalities on brain imaging and lower prevalence of organ failure. Diagnosis and treatment of NCS should be a priority in encephalopathic cancer patients, as they can have lower mortality than non-seizing patients. Opposite to other populations, NCS should not be considered a poor prognostic factor in critically ill encephalopathic cancer patients as they reflect a reversible cause for altered mentation.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Non-convulsive seizures in the encephalopathic critically ill cancer patient does not necessarily portend a poor prognosis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Resultsmentioning

confidence: 99%

Outcomes in Patients With Poststroke Seizures

Misra,

Kasner,

Dawson

et al. 2023

JAMA Neurol

View full text Add to dashboard Cite

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.

show abstract

“…2 Seizures after stroke could negatively affect the prognosis of the stroke and cause a decrease in quality of life. [3][4][5] The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment for acute ischemic stroke has been demonstrated in many studies, and IV rt-PA treatment for acute ischemic stroke has been increasingly used around the world. 6,7 There is no consensus on how IV rt-PA treatment affects seizures after acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

“…2 Seizures after stroke could negatively affect the prognosis of the stroke and cause a decrease in quality of life. 3 4 5…”

Section: Introductionmentioning

confidence: 99%

Specificity and sensitivity of the SeLECT score in predicting late seizures in patients undergoing intravenous thrombolytic treatment and the effect of diabetes mellitus and leukoaraiosis

et al. 2023

View full text Add to dashboard Cite

Background Seizures after stroke can negatively affect the prognosis of ischemic stroke and cause a decrease in quality of life. The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment in acute ischemic stroke has been demonstrated in many studies, and IV rt-PA treatment has been increasingly used around the world. The SeLECT score is a useful score for the prediction of late seizures after stroke and includes the severity of stroke (Se), large artery atherosclerosis (L), early seizure (E), cortical involvement (C), and the territory of the middle cerebral artery (T). However, the specificity and sensitivity of the SeLECT score have not been studied in acute ischemic stroke patients that received IV rt-PA treatment. Objective In the present study, we aimed to validate and develop the SeLECT score in acute ischemic stroke patients receiving IV rt-PA treatment. Methods The present study included 157 patients who received IV thrombolytic treatment in our third-stage hospital. The 1-year seizure rates of the patients were detected. SeLECT scores were calculated. Results In our study, we found that the SeLECT score had low sensitivity but high specificity for predicting the likelihood of late seizure after stroke in patients administered IV rt-PA therapy. In addition to the SeLECT score, we found that the specificity and sensitivity were higher when we evaluated diabetes mellitus (DM) and leukoaraiosis. Conclusion We found that DM was an independent risk factor for late seizures after stroke in a patient group receiving thrombolytic therapy, and late seizures after stroke were less frequent in patients with leukoaraiosis.

show abstract

In‐hospital costs in patients with seizures and epilepsy after stroke

Cited by 12 publications

References 22 publications

Non-convulsive seizures in the encephalopathic critically ill cancer patient does not necessarily portend a poor prognosis

Non-convulsive seizures in the encephalopathic critically ill cancer patient does not necessarily portend a poor prognosis

Outcomes in Patients With Poststroke Seizures

Specificity and sensitivity of the SeLECT score in predicting late seizures in patients undergoing intravenous thrombolytic treatment and the effect of diabetes mellitus and leukoaraiosis

Contact Info

Product

Resources

About