Incidence of early poststroke seizures during reperfusion therapies in patients with acute ischemic stroke: An observational prospective study

Belcastro, Vincenzo; Brigo, Francesco; Ferlazzo, Edoardo; Gasparini, Sara; Mastroianni, Giovanni; Cianci, Vittoria; Lattanzi, Simona; Silvestrini, Mauro; Versino, Maurizio; Banfi, Paola; Carimati, Federico; Grampa, G; Lochner, Piergiorgio; Gigli, Gian Luigi; Bax, Francesco; Merlino, Giovanni; Valente, Mariarosaria; Vidale, Simone; Aguglia, Umberto

doi:10.1016/j.yebeh.2019.106476

Cited by 29 publications

(33 citation statements)

References 21 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%

“…Frequencies of acute symptomatic seizures noted by us are similar to those in several other studies in patients who underwent recanalization treatments, ranging between 1.2 and 3.8% 25,29,31,32 , with only two studies that reported higher frequencies between 8.1 and 23.4% 26,30 . 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.…”

Section: Discussionsupporting

confidence: 89%

“…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%. Only a few studies have investigated the effect of MT on the frequency of acute symptomatic seizures 23,[31][32][33] .…”

Section: Scientific Reportsmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 89%

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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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“…Another large systematic review and meta-analysis by Lekoubou et al determined that the rate of early PSS was similar between patients who received tPA and patients who did not ( 5 ). A prospective, multicenter study by Belcastro et al found no significant difference in the rate of early PSS in 262 patients who received tPA compared with 254 patients who did not ( 19 ). Another prospective study also found no significant difference in the rate of early PSS in 101 patients treated with tPA and 50 patients treated without tPA ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…The effect of reperfusion therapies on early PSS, in particular, is a seldomly studied question. Most studies have small sample sizes, and the results are mixed showing decreased ( 16 ), increased ( 17 , 18 ), or no effect ( 5 , 19 ) of initial treatment modality on the incidence of early PSS. Some studies theorize that reperfusion therapies increase the risk of seizures, as treated patients tend to present with more hemorrhagic transformation, a strong risk factor for the development of early PSS ( 20 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of Reperfusion Therapies on Incidence of Early Post-Stroke Seizures

et al. 2021

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Objective: This study aimed to determine the effect of reperfusion therapies on the occurrence of early post-stroke seizures (PSS) in patients with acute ischemic stroke (AIS).Background: Reperfusion therapies are paramount to the treatment of stroke in the acute phase. However, their effect on the incidence of early seizures after an AIS remains unclear.Design and Methods: The stroke database at Hamad Medical Corporation was used to identify all patients who received reperfusion therapies for AIS from 2016 to 2019. They were matched with patients of similar diagnosis, gender, age, and stroke severity as measured by National Institutes of Health Stroke Scale (NIHSS) who did not receive such treatment. The rates of early PSS were calculated for each group.Results: The results showed that 508 patients received reperfusion therapies (342 had IV thrombolysis only, 70 had thrombectomies only, and 96 had received both), compared with 501 matched patients receiving standard stroke unit care. Patients who received reperfusion therapies were similar to their matched controls for mean admission NIHSS score (9.87 vs. 9.79; p = 0.831), mean age (53.3 vs. 53.2 years; p = 0.849), and gender distribution (85 vs. 86% men; p = 0.655). The group receiving reperfusion therapies was found to have increased stroke cortical involvement (62 vs. 49.3%, p < 0.001) and hemorrhagic transformation rates (33.5 vs. 18.6%, p < 0.001) compared with the control group. The rate of early PSS was significantly lower in patients who received reperfusion therapies compared with those who did not (3.1 vs. 5.8%, respectively; p = 0.042). When we excluded seizures occurring at stroke onset prior to any potential treatment implementation, the difference in early PSS rates between the two groups was no longer significant (2.6 vs. 3.9%, respectively; p = 0.251). There was no significant difference in early PSS rate based on the type of reperfusion therapy either (3.2% with thrombolysis, 2.9% with thrombectomy, and 3.1% for the combined treatment, p = 0.309).Conclusions: Treatment of AIS with either thrombectomy, thrombolysis, or both does not increase the risk of early PSS.

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Seizures after Ischemic Stroke: A Matched Multicenter Study

Ferreira‐Atuesta

Döhler

Erdélyi-Canavese

et al. 2021

Annals of Neurology

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The purpose of this study was to identify risk factors for acute symptomatic seizures and post-stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. Methods: We assessed the risk factors for post-stroke seizures using logistic or Cox regression in a multicenter study, including adults from 8 European referral centers with neuroimaging-confirmed ischemic stroke. We compared the risk of post-stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. Results: In the overall cohort of 4,229 participants (mean age 71 years, 57% men), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and

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Incidence of early poststroke seizures during reperfusion therapies in patients with acute ischemic stroke: An observational prospective study

Cited by 29 publications

References 21 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

Effect of Reperfusion Therapies on Incidence of Early Post-Stroke Seizures

Seizures after Ischemic Stroke: A Matched Multicenter Study

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