Post‐stroke seizure—Do the locations, types and managements of stroke matter?

Abstract

SummaryObjectiveTo determine the incidence of post‐stroke seizures and the associated risk factors in a government‐restructured hospital in Singapore.MethodsThis retrospective study included consecutive patients (age ≥21 years) admitted to the stroke rehabilitation facility at Changi General Hospital, Singapore, between June 2008 and May 2017, with a minimum post‐discharge follow‐up of 6 months. Patients with known epilepsy central nervous system infection or tumor, a history of neurosurgery and or missing data were excluded from study. To determine the incidence of seizures, the patients’ hospital records, including those for all initial and subsequent admissions and outpatient follow‐ups, were reviewed. All prescribed medications were checked and documented. Seizures were diagnosed on the basis of clinical examination with or without electroencephalography.ResultsIn total, 722 patients (women, 38%) with a mean age of 64 years were included. Of these, 48 (6.64%) experienced post‐stroke seizures during a follow‐up period of 6–108 months. The incidence of seizures was significantly higher in patients with hemorrhagic stroke (42%, p = 0.010), those with ischemic partial anterior circulation stroke (PACS) (27%, p = 0.025), those who underwent a neurosurgical procedure after stroke (p < 0.001), those with a low activated partial thromboplastin time (APTT) at admission (mean, 25.6; p = 0.015), and those using levodopa (21%, p < 0.001). Neurosurgical intervention after stroke (odds ratio [OR] 6.2, 95% confidence interval [CI] 2.9–13.1; p < 0.001), APTT (per‐unit increase; OR 0.86, 95% CI 0.76–0.98; p = 0.028), and underlying ischemic heart disease (IHD; OR 2.2, 95% CI 1.08–4.60; p = 0.029) were found to be independent predictors of seizure occurrence after stroke.SignificancePost‐stroke seizure incidence from our study is 6.64%, with a median follow‐up of 49 months. Among patients with stroke, those with underlying IHD, those who undergo a neurosurgical procedure, and those with a low APTT at admission need careful monitoring. Levodopa should be used with caution and withdrawn as soon as possible.

Incidence, Implications, and Management of Seizures Following Ischemic and Hemorrhagic Stroke

“…Approximately 9.8% of patients with cortical lesions had post-stroke seizures compared to 3.8% risk in subcortical lesions in one study [22]. Strokes in anterior vascular territories are more likely to cause seizures compared to posterior ones attributed to the fact that the anterior vascular territory involves larger areas of the cortex [24]. In addition, there appears to be an association with increased risk for development of stroke related epilepsy if the temporal lobes are affected [25][3].…”

“…The incidence of seizures following strokes varies greatly from 2% to 20% [6][7][8][24][29] and overall seem to have a higher incidence following hemorrhage stroke [30] and following SAH [31] (Table 2.). One of the largest prospective multicenter studies showed the overall incidence of seizures to be about 10.6% following ICH and about 8.6% following ischemic strokes [16].…”

Role of vinpocetine in ischemic stroke and poststroke outcomes: A critical review

“…[59] The antiepileptic mechanisms of VPN are through blockade of presynaptic Na-channel-mediated glutamate release, inhibition of TNF-α and IL-1 β which play a role in the augmentation of presynaptic Ca and Na permeability. [60,61] The site of stroke lesions has been reported as a chief clinical factor enduring tendency to generate further and additional seizures. Several studies have established that early PSS is an independent risk factor for the development of late and repeated seizures.…”

En kvinne i 60-årene med epilepsi og synkope

“…Tilstanden er hyppigere hos eldre pasienter og defineres som to eller flere tilbakevendende anfall mer enn fire uker e er gjennomgå hjerneslag (7). Infarktets størrelse ser ut til å vaere en risikofaktor (6, 7), noe som kan forklare at hjerneslag i fremre del av hjernens kretsløp i større grad ser ut til å føre til epilepsi enn hjerneslag i bakre kretsløp, fordi det involverer større deler av hjernen (8). Det ser også ut til at affeksjon av temporallappene øker risikoen for utvikling av senere epilepsi (9).…”