Seizures and epilepsy in patients with ischaemic stroke

Abstract

Background With the increased efficacy of stroke treatments, diagnosis and specific treatment needs of patients with post-stroke seizures (PSS) and post-stroke epilepsy have become increasingly important. PSS can complicate the diagnosis of a stroke and the treatment of stroke patients, and can worsen post-stroke morbidity. This narrative review considers current treatment guidelines, the specifics of antiseizure treatment in stroke patients as well as the state-of-the-art in clinical and imaging research of post-stroke epilepsy. Treatment of PSS needs to consider indications for antiseizure medication treatment as well as individual clinical and social factors. Furthermore, potential interactions between stroke and antiseizure treatments must be carefully considered. The relationship between acute recanalizing stroke therapy (intravenous thrombolysis and mechanical thrombectomy) and the emergence of PSS is currently the subject of an intensive discussion. In the subacute and chronic post-stroke phases, important specific interactions between necessary antiseizure and stroke treatments (anticoagulation, cardiac medication) need to be considered. Among all forms of prevention, primary prevention is currently the most intensively researched. This includes specifically the repurposing of drugs that were not originally developed for antiseizure properties, such as statins. PSS are presently the subject of extensive basic clinical research. Of specific interest are the role of post-stroke excitotoxicity and blood–brain barrier disruption for the emergence of PSS in the acute symptomatic as well as late (> 1 week after the stroke) periods. Current magnetic resonance imaging research focussing on glutamate excitotoxicity as well as diffusion-based estimation of blood–brain barrier integrity aim to elucidate the pathophysiology of seizures after stroke and the principles of epileptogenesis in structural epilepsy in general. These approaches may also reveal new imaging-based biomarkers for prediction of PSS and post-stroke epilepsy. Conclusion PSS require the performance of individual risk assessments, accounting for the potential effectiveness and side effects of antiseizure therapy. The use of intravenous thrombolysis and mechanical thrombectomy is not associated with an increased risk of PSS. Advances in stroke imaging may reveal biomarkers for PSS.

Diffuse low-grade glioma misdiagnosed as acute cerebral infarction: A case report

“…[11] Most clinical evidences show that the use of intravenous thrombolysis and mechanical thrombectomy does not increase the risk of post-stroke epilepsy, and post-thrombolysis hemorrhagic transformation is an independent risk factor for post-stroke epilepsy or epilepsy. [12] In this case, no evidence of bleeding was found during the CT scan, and CE-MRA showed no large vessel occlusion during reexamination, which did not support the hypothesis of post-thrombolysis hemorrhagic transformation or epilepsy after massive stroke. As a common symptom of temporal lobe epilepsy, olfactory disorder is manifested by hyposmia or anosmia in most cases.…”

Feasibility and psychophysical effects of immersive virtual reality-based mirror therapy

“…When applying non-VR specific rehabilitation protocols to immersive VR setups, the potential hindrances of VR need to be accounted for (potential for simulator sickness, safety of the user while the headset is on, sanitation of the hardware/setup, etc). Stroke survivors bear a considerable risk for developing seizures or epilepsy (more pronounced for hemorrhagic than ischemic stroke [52]). Thus, there is some concern about eliciting visually sensitive seizures when using VR setups for rehabilitation.…”

Antiepileptic pharmacotherapy in old age: evidence-based approach versus clinical routine – English Version

“…To more accurately and individually predict the likelihood of recurrence of further seizures depending on factors such as age, duration of hospi-talization in the acute care hospital, early seizures, or vascular risk factors, different models and scales for risk at 1 year [9, 58] or at 5 years [20] have been developed and validated. In this context, it is also interesting that it was recently possible to confirm the assumption that recanalization therapies such as intravenous lysis therapy or mechanical catheter thrombectomy have no effect either on the occurrence of acute symptomatic (early) seizures or post-stroke epilepsy [69].…”