Stroke-related early seizures: clinical and neurophysiological study in a sample of Egyptian population

Abstract

Background Available data collected from patients of different types of acute cerebrovascular strokes can detect risk factors, clinical data (including semiology of seizures), EEG findings and functional outcome of these patients. Stroke, both ischemic and hemorrhagic, has been considered an essential cause of epilepsy, especially in the elderly. Complications of acute stroke during the early days after the insult determine the ultimate outcome of events. The aim of this study is to determine the clinical and neurophysiological characteristics of stroke patients with or without clinical evident fits for early detection and better management. Results The brain imaging of the cases group who developed seizures showed that 50% of the cases have arterial ischemic infarction, 30% venous infarction, 6.67% ischemic infarction with haemorrhagic transformation, 6.67% intracerebral haemorrhage and 6.67% have subarachnoid haemorrhage. Based on the 2017 ILAE criteria, 43.33% of the patients developed focal to bilateral tonic clonic seizures, 33.33% developed focal aware seizures, 16.67% of the patients developed generalized tonic clonic seizures and 6.67% of the patient developed status epilepticus. EEG findings of the group of patients who developed seizures showed, focal slowing in 46.67%, focal epileptiform activity in 13.33%, focal activity with secondary generalization in 10%, PLEDS in 6.67%, generalized epileptiform activity in 6.67%, generalized slowing in 6.67% and normal EEG in 10% of the patients. Non convulsive status was found in 2 patients (6.67%) of the group with altered mental status. There was no PLEDS in EEG of group of patients without clinical seizures. This study did not find age and sex differences in patients with and without seizures. In addition, it was found that there was no statistically significant difference between the three groups as regard history of diabetes mellitus, hypertension, heart diseases, atrial fibrillation, carotid stenosis and collagen diseases. There was no significant relationship between seizures and early treatment with Rtpa and thrombectomy. Conclusions Focal to bilateral tonic clonic and focal aware seizures were the most prevalent type of early onset seizures after stroke, followed by generalized tonic clonic seizures and status epilepticus. Most EEG findings in this study were focal slowing, focal epileptiform activities, generalized epileptiform activities and PLEDS.

Outcomes in Patients With Poststroke Seizures

“…Our search yielded 71 studies (Figure 1). There was 1 ambispective, 20 prospective, 47 retrospective cohort studies, and 3 case-control studies. All studies were published in English, and we identified no studies in other languages.…”

“…The articles included 1967 patients (9.8%) with early seizures and 10 605 patients (52.7%) with late seizures after stroke; 7538 seizures (37.5%) were not classified as early or late. PSS were diagnosed according to clinical or medical chart data in 59 studies and using the ICD-10 codes in 12 studies (including 15 033 patients [74.8%]). Patients with PSS had a significantly higher history of ischemic heart disease (OR, 1.3; 95% CI, 1.1-1.6), prior cerebrovascular disease (OR, 1.3; 95% CI, 1.0-1.6), atrial fibrillation (OR, 1.2; 95% CI, 1.1-1.4), and the presence of hemorrhagic transformation (OR, 2.2; 95% CI, 1.6-3.0) than patients without PSS (eTable 3 in Supplement 1).…”

“…Five studies (7.0%) had a high risk of bias, 35 studies (49.3%) presented a moderate risk of bias, and 31 studies (43.7%) had a low risk of bias (eTable 4 in Supplement 1).…”

“…Only 37 studies (52.1%) provided complete follow-up data. The outcomes were measured validly and reliably in 53 studies (74.6%) …”

“…In 57 studies, patients with PSS had approximately double the risk of death (OR, 2.1; 95% CI, 1.8 to 2.4; I 2 = 86%) with substantial heterogeneity (Figure 2). The funnel plot was symmetric, and no publication bias was observed (Egger P value = 0.4) (eFigure 2A in Supplement 1).…”