Incidence and predictors for post‐stroke epilepsy. A prospective controlled trial. The Akershus stroke study

Lossius, Morten I.; Rønning, Ole Morten; Mowinckel, Petter; Gjerstad, Leif

doi:10.1046/j.1468-1331.2002.00415.x

Cited by 42 publications

(29 citation statements)

References 32 publications

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“…In contrast to previous studies [5,34,35,36], we did not find a relationship between the severity of the stroke and the occurrence of seizures.…”

Section: Discussioncontrasting

confidence: 99%

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Are Early Seizures Predictive of Epilepsy after a Stroke? Results of a Population-Based Study

Serafini¹,

Gigli²,

Gregoraci³

et al. 2015

Neuroepidemiology

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Background: In addition to determining the cumulative incidence and risk factors for early seizures (ES), late seizures (LS) and post stroke epilepsy (PSE), we aimed at checking if ES represented a risk factor for epilepsy and if early treatment after ES prevented the occurrence of subsequent seizures. Methods: This study was part of a 2-year prospective community-based registry of all cerebrovascular events in the district of Udine (153,312 inhabitants), North-Eastern Italy, between April 1, 2007 and March 31, 2009. People with transient ischemic attacks (TIAs) were excluded from this study. Results: In all, 782 cases of stroke (79.28% ischemic, 14.83% hemorrhagic, 3.20% subarachnoid hemorrhage and 2.69% undetermined) were identified. The incidence of ES, LS and PSE was 5.10, 3.14 and 2.22%, respectively. Intracerebral hemorrhage, subarachnoid hemorrhage, stroke of undetermined origin and hyponatremia, represented risk factors for ES (p < 0.05). Among ischemic strokes, ES risk factors were hyponatremia (p = 0.024) and hemorrhagic transformation (p = 0.046). LS risk factors were younger age (p = 0.004) and cortical location of stroke (p = 0.004). Within ischemic strokes, LS risk factors were younger age (p = 0.020) and cortical location (p < 0.0001). Within intracerebral hemorrhages, the only risk factor for LS was the presence of a previous ES (p = 0.017). PSE risk factors were the same as for LS. Conclusions: All acute conditions related to the occurrence of stroke are implicated in the pathogenesis of ES, which becomes a risk factor for LS only in the setting of intracerebral hemorrhages. Therefore, early antiepileptic treatment is needed only in this situation.

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“…In contrast to previous studies [5,34,35,36], we did not find a relationship between the severity of the stroke and the occurrence of seizures.…”

Section: Discussioncontrasting

confidence: 99%

“…This topic has been addressed through many epidemiological studies [3,4,5,6,7]. The results, however, vary between studies, mostly because of the different study design, size and type of population, duration of follow-up and because of the different definitions used to identify seizures.…”

Section: Introductionmentioning

confidence: 99%

Are Early Seizures Predictive of Epilepsy after a Stroke? Results of a Population-Based Study

Serafini¹,

Gigli²,

Gregoraci³

et al. 2015

Neuroepidemiology

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“…We found only one previous study that had analyzed age as a risk factor for developing PSE and in that study age was not found to be an independent predictor of PSE. 1 However, in that study the follow-up period was considerably shorter and the cohort investigated smaller than the current one. We found no differences in the univariate analyses when stroke severity at onset between patients with versus without PSE was compared.…”

Section: Discussionmentioning

confidence: 68%

“…2 A Norwegian study found an initial stroke severity below 30 points on the SSS score to significantly increase the risk for PSE within 12 months after stroke onset. 1 Lesion size appeared to be a significant independent predictor for developing PSE. An increase of the lesion diameter by 10 mm on CT scans corresponded to a 16% higher relative risk for PSE within 7 years after stroke onset.…”

Section: Discussionmentioning

confidence: 90%

“…Hence, identification of factors that predict epilepsy in patients with stroke is warranted. Age, stroke severity, cortical stroke, and hemorrhagic stroke are often found to be predictors in most studies, [1][2][3] but not in all reports. 4 Timing of first seizure (early v late after stroke) 3,5 and stroke recurrence 6 are among other suggested predictive factors for poststroke epilepsy (PSE).…”

mentioning

confidence: 99%

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Poststroke Epilepsy in the Copenhagen Stroke Study: Incidence and Predictors

Kammersgaard

Olsen

2005

Journal of Stroke and Cerebrovascular Diseases

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Association Between Antiseizure Drug Monotherapy and Mortality for Patients With Poststroke Epilepsy

et al. 2022

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The relationship between epilepsy and stroke is complicated. While stroke is a major cause of epilepsy after middle age, there is also evidence that the risk of stroke is increased in persons with epilepsy. The overall aim of this dissertation is to elaborate on the prognosis and treatment of epilepsy in older adults and its association to stroke. It is based on four studies which have been conducted using information from linked national registers, which offer unique opportunities to follow thousands of patients over a long period of time.The results from Papers I-II indicate that a significant proportion of all newonset seizures after middle age will herald a subsequent stroke. Using incidence data and population statistics, we estimated the 10-year risk of stroke to be between 5-20%, depending on age group. In relative terms, the risk appears to be almost two-fold (odds ratio [OR] 1.77; 95% confidence interval [95%CI] 1.65-1.89) compared with age-matched controls from the general population -and highest during the first year after seizure onset (OR 2.21; 95 % CI 1.79-2.72).The studies described in Papers III-IV examined prognostic aspects of antiseizure medication (ASM) therapy in poststroke epilepsy. Paper III found the 5-year retention rate to be highest for lamotrigine (0.75, 95%CI 0.70-0.79) and levetiracetam (0.69, 95%CI 0.63-0.74), suggesting these drugs are well tolerated in this patient group. Paper IV used a similar methodology but investigated if mortality varied with different ASMs in monotherapy. Patients treated with lamotrigine had lower mortality (hazard ratio [HR] 0.72, 95%CI 0.60-0.86) than the reference group treated with carbamazepine, while patients treated with valproic acid had higher mortality (HR 1.40, 95%CI 1.23-1.59). Treatment with levetiracetam was associated with a reduced risk of cardiovascular death compared to carbamazepine (HR 0.77, 95%CI 0.60-0.99).In conclusion, this thesis supports a tailored management approach in adults with new-onset seizures late in life, particularly in those with a history of stroke. Persons with late-onset seizures have high vascular risk, potentially warranting screening and treatment for vascular risk factors. Moreover, the association between ASM selection and mortality raises concerns about clinically relevant drug-drug or drug-disease interactions that may modify vascular risk. Overall, lamotrigine and levetiracetam seem sensible initial treatment options in this patient group.

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Incidence and predictors for post‐stroke epilepsy. A prospective controlled trial. The Akershus stroke study

Cited by 42 publications

References 32 publications

Are Early Seizures Predictive of Epilepsy after a Stroke? Results of a Population-Based Study

Are Early Seizures Predictive of Epilepsy after a Stroke? Results of a Population-Based Study

Poststroke Epilepsy in the Copenhagen Stroke Study: Incidence and Predictors

Association Between Antiseizure Drug Monotherapy and Mortality for Patients With Poststroke Epilepsy

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