Influence of seizures on stroke outcomes

Huang, Chin Wei; Saposnik, Gustavo; Fang, J; Steven, David; Burneo, Jorge G.

doi:10.1212/wnl.0000000000000166

Cited by 117 publications

(124 citation statements)

References 35 publications

Supporting

Mentioning

110

Contrasting

Order By: Relevance

“…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%

“…Mortality appears to be related more to the severity of the stroke. Our data, however, are in contrast with results from other studies in which patients with a post-stroke seizure had higher morbidity and mortality [35]. However, a more focused analysis of mortality in this population will be the topic of a future article.…”

Section: Discussioncontrasting

confidence: 98%

“…Also in this case, because of the rarity of this condition, we are cautious about our conclusions; however, we included the smallest possible number of covariates in our models and feel confident in arguing that our findings agree with most studies in the literature [35,36]. Furthermore, within the subpopulation of patients with ischemic stroke, the cortical location of stroke seems to increase the risk of having LS.…”

Section: Discussionmentioning

confidence: 57%

See 2 more Smart Citations

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

Serafini¹,

Gigli²,

Gregoraci³

et al. 2015

Neuroepidemiology

View full text Add to dashboard Cite

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.

show abstract

“…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%

Section: Discussioncontrasting

confidence: 98%

Section: Discussionmentioning

confidence: 57%

See 1 more Smart Citation

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

Serafini¹,

Gigli²,

Gregoraci³

et al. 2015

Neuroepidemiology

View full text Add to dashboard Cite

show abstract

“…Cortical location, larger infarct sizes, and hemorrhagic transformation have been associated with an increased risk for the development of seizures following ischemic stroke [6]. The occurrence of early seizures after ischemic stroke is associated with poor functional outcome and higher mortality [7,8]. Two recent studies have shown an increased risk of seizures (including electrographic seizures) with the presence of epileptiform patterns (including PP) in neurocritical care patients [9,10].…”

Section: Introductionmentioning

confidence: 99%

Electroencephalography Patterns and Prognosis in Acute Ischemic Stroke

et al. 2017

View full text Add to dashboard Cite

Background and Purpose: The prognostic significance of interictal epileptiform discharges (IED) and periodic patterns (PP) after ischemic stroke has not been assessed. We sought to test whether IED and PP, detected on standard Electroencephalography (EEG) performed during the acute phase of ischemic stroke are associated with a worse functional outcome. Methods: One-hundred-fifty-seven patients 18 years or older with a diagnosis of acute ischemic stroke presenting within 72 h from stroke onset were prospectively enrolled and followed. Patients with a pre-stroke history of seizures or epilepsy, previous debilitating neurological disease or conditions that precluded the performance of EEG were excluded. Interpretation was performed by a blinded board certified neurophysiologist. IED and PP (grouped as epileptiform activity [EA]) were defined according to proposed guidelines. Univariable and multivariable analyses were used to identify predictors of outcome (modified Rankin Scale dichotomized ≤2 vs. ≥3) at 3 months. Results: In the univariable analysis, admission NIHSS (OR 1.20, 95% CI 1.12-1.28, p = 0.001), age (OR 1.03, 95% CI 1.01-1.05, p = 0.02), and presence of EA (OR 2.94, 95% CI 1.51-5.88, p = 0.001) were significantly associated with the outcome at 3 months. In the multivariable analysis, only admission NIHSS (OR 1.19, 95% CI 1.11-1.28, p < 0.001) and the presence of EA (OR 2.27, 95% CI 1.04-5.00, p = 0.04) were independently associated with the prognosis. Significance: The importance of EEG in the prognosis of acute ischemic stroke warrants additional research, examining the role of medication therapy on the outcome and the occurrence of seizures for those patients with specific EEG patterns.

show abstract

“…2 On the other hand, epileptic seizures following stroke 3,4 and electrographic seizures and interictal epileptiform discharges in critically ill patients are known to worsen the outcome. [5][6][7] The current International League Against Epilepsy (ILAE) definition of epilepsy 8 allows for the diagnosis of epilepsy after a single unprovoked seizure, provided that there is at least a 60% probability of recurrence, as it is the case of the first unprovoked seizure after the acute stroke phase.…”

Section: Introductionmentioning

confidence: 99%

Frequency of post-stroke electroencephalographic epileptiform activity – a systematic review and meta-analysis of observational studies

Bentes

Rodrigues

Sousa

et al. 2017

European Stroke Journal

View full text Add to dashboard Cite

Introduction: Cerebrovascular diseases are the most frequent risk factor for epilepsy in the elderly, and epileptic phenomenon following stroke is known to worsen the prognosis. Although electroencephalography is the gold standard epilepsy biomarker, it is rarely used in post-stroke studies, and the frequency of post-stroke epileptiform activity is still uncertain. Patients and methods: We analysed studies indexed to MEDLINE, Embase, Web of Science, PsycINFO and OpenGrey (up to March 2015), reporting post-stroke electroencephalographic epileptiform activity frequency in adults. Epileptiform activity was classified as ictal (electrographic seizures) and interictal (non-periodic spikes and sharp waves). Data selection, extraction and appraisal were done in duplicate. Random-effects meta-analysis was used to pool frequencies. Results: The pooled frequency of post-stroke ictal and interictal epileptiform activity was 7% (95% CI 3%-12%) and 8% (95% CI 4%-13%), respectively. The use of continuous electroencephalogram was not associated with an increased frequency of electrographic seizures (p ¼ 0.05), nor did the management setting (Intensive Care Unit versus nonIntensive Care Unit, p ¼ 0.31). However, studies with continuous electroencephalogram showed a higher frequency of interictal epileptiform activity (p ¼ 0.01). Discussion: This study provides the best available estimates of the frequency of post-stroke electroencephalographic epileptiform activity. Due to detection bias, it was not possible to correlate clinical and electrographic seizures. Conclusion: The frequency of ictal and interictal epileptiform activity in the electroencephalogram was comparable with previous frequency analyses of clinical seizures. The frequency of ictal epileptiform activity did not change with continuous record or clinical setting, while the frequency of interictal epileptiform activity increased with continuous record.

show abstract

Influence of seizures on stroke outcomes

Abstract: SSP and SDH have different characteristics. SDH indicates a poorer prognosis in patients. Increased awareness of SSP and efforts to prevent SDH may be important in improving outcomes following clinical stroke care.

Cited by 117 publications

References 35 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

Electroencephalography Patterns and Prognosis in Acute Ischemic Stroke

Frequency of post-stroke electroencephalographic epileptiform activity – a systematic review and meta-analysis of observational studies

Contact Info

Product

Resources

About