The pooled incidence of post-stroke seizure in 102 008 patients

Background: Post-stroke seizures and epilepsy may worsen the recovery and increase the disability of stroke patients during their daily lives. However, few meta-analysis studies have been conducted on post-stroke seizures incidence. We carried on a meta-analysis on the incidence rate of post-stroke seizures and associated factors.

Methods: We searched the Medline, Embase, Web of Science, Science Citation Index, and Cochrane Library electronic databases (1990–2013) to identify observational studies of post-stroke seizures. Two authors independently extracted the related information from all included studies. We calculated the pooled incidence by meta-analysis using the software R version 12.3.

Results: A total of 34 longitudinal cohort studies involving 102?008 patients were included in our meta-analysis. The pooled incidence rate of post-stroke seizures was found to be 0.07 [95% confidence interval (CI), 0.05–0.09] while the rate of post-stroke epilepsy (PSE) was 0.05 (95% CI, 0.04–0.06). The incidence of post-stroke seizures in hemorrhagic stroke (0.10, 0.08–0.13) was much higher than in ischemic stroke (0.06, 0.04–0.08) and when the cortical region was involved (0.15, 0.10–0.21).

Conclusions: Our meta-analysis showed that seizures occurred in about 6.93% of people with stroke. Seizures occurred more commonly after hemorrhagic stroke and when stroke occurred in the cortical region.     

老年人卒中后痫样发作现象的调查研究

This prospective study sought to investigate the clinical,radiological and electroencephalographic(EEG) characteristics of seizures in elderly stroke patients,and their outcomes.Over a 2-year study period,158 consecutive elderly patients with stroke were examined and followed up.Of these patients,32(20%) developed seizures,primarily related to stroke,within a follow up period between 5 months and 2 years.Of these 32 cases,20 experienced infarctions,and 12 experienced hemorrhages.Involvement of cortical regions was detected in most of the patients exhibiting seizures.In these patients,44% of the lesions involved cortical areas exclusively or in addition to subcortical areas observed on computed tomography(CT) images.Twenty-five patients(78%) developed early seizures(within 2 weeks after stroke),and half exhibited immediate post-stroke seizures.None of the patients exhibiting early onset seizures developed recurrent seizures or epilepsy,while 57% of late onset seizures(four cases) developed epilepsy.No specific EEG patterns were apparent in those who later developed epilepsy.Overall,early onset seizures after stroke were found to be relatively common,and did not affect outcome.Late onset seizures were less common,but were associated with chronic epilepsy.     

Seizures after cerebrovascular events: Risk factors and clinical features

BackgroundEpileptic seizures are well known sequelae of patients with stroke but only little is known about the different risk factors and about the influence of the different types of stroke including sinus thrombosis and bleedings on developing such seizures. Further, the association of post-stroke seizures and conventional vascular risk factors has not been evaluated to date.MethodsWe performed a cohort study on a sample of 593 consecutive patients with different types of cerebrovascular events. In 421 patients, sufficient data were obtained in a personal interview over a mean observation period of 30 months. Data regarding the clinical history were recorded from the patients’ charts.ResultsThe total prevalence of epileptic seizures was 11.6%, the total annual risk was 4.6%. We detected the following significant risk factors: younger age at stroke; higher NIH stroke scale score; any coagulopathy. TIA was found significantly less frequent as a cause of seizures as compared to infarction, bleeding, and sinus thrombosis. Patients with bleeding (14.3%) and with sinus thrombosis (16.3%) were significantly more frequent in the seizure group than in the non-seizure group (6.7% and 1.6%, respectively). The location of stroke, including cortical versus subcortical, did not influence the risk of seizures. The majority of patients developed secondary generalized seizures (57.1%). In adjusted analyses, the two major risk factors for post-stroke epilepsy were a higher NIH stroke scale and a sinus thrombosis as the initial cerebrovascular event. Common lifestyle, vascular, and metabolic risk factors of stroke and for dementia were not associated with the development of seizures.ConclusionsIn conclusion, our data show that epileptic seizures occur in particular after major strokes and in sinus thrombosis. Interestingly, conventional vascular risk factors were not associated with the occurrence of post-stroke seizures. Considering the risk for seizures after certain types of cerebrovascular events might help to early identify patients for anticonvulsive treatment. In the future, it should be investigated whether these patients might benefit from pre-emptive anticonvulsant treatment.     

Seizures after stroke : a prospective clinical study

Stroke is one of the most common causes of epilepsy in elderly. However, there have been very few prospective studies to define the incidence, pattern and outcome of seizures in stroke. Most studies are based on retrospective analysis of hospital records. Hence, we planned this prospective study to see the clinical, radiological and electroencephalographic characteristics of seizures in stroke and their outcome, from a north Indian tertiary care centre. Over a span of approximately 6 years, 269 consecutive patients with stroke were studied and followed up. Thirty-five (13%) of these developed seizures, primarily related to stroke, during mean follow up period of 15.9 months. Twenty of these had infarctions while 15 had haemorrhages. Involvement of the cortical region was seen in most of the patients with seizures. In these patients, 86% of the lesions involved cortical areas exclusively or in addition to subcortical areas on CT scan of the brain. Twenty-seven (77%) developed early seizures, two third of them had immediate post-stroke seizures. None of the patients with early onset seizures developed recurrent seizures or epilepsy, while 50% of late onset seizures developed epilepsy. No specific EEG pattern was found in those who later developed epilepsy. In the present study, early onset seizures after stroke were rather common and did not affect outcome and did not recur even when not treated with anti-epileptics. Late onset seizures were less common but were associated with recurrent seizures.     

卒中后癫痫发作的临床研究进展

卒中后癫痫发作和卒中后癫痫是常见的卒中并发症,给患者及其家属的身心健康带来巨大影响,但目前仍缺乏明确的预防和诊治指南。不同类型的卒中可引起不同类型的癫痫发作和癫痫,且其相应的危险因素亦不相同。脑出血是目前公认度较高的卒中后癫痫发作或卒中后癫痫的首要危险因素。鉴于相关的评估手段和干预策略尚处于研究阶段,因此针对主要危险因素的干预成为当前较为可行的应对选择。卒中后癫痫发作和卒中后癫痫的诊断和治疗同样面临着不少困难。目前,头颅磁共振成像(magnetm resonance imaging,MRI)动脉自旋标记(arterial spin labeling,ASL)序列和新一代抗癫痫药物左乙拉西坦已成为关注的焦点。本文对近年来有关卒中后癫痫发作和卒中后癫痫的危险因素及临床诊治的研究进展进行总结和讨论。     

SPECT-DTPA as a tool for evaluating the blood–brain barrier in post-stroke seizures

Stroke is a well-known cause for seizures in the adult population. Research in animal models indicates that abnormalities in the blood-brain barrier (BBB) permeability can play a role in the development of spontaneous seizures or status epilepticus. The integrity of the BBB was investigated in patients with late post-stroke seizures by performing DTPA-SPECT studies to evaluate the correlation of BBB dysfunction in late post-stroke seizures. All patients with late-onset post-cortical stroke seizures hospitalized during 2009-2010 underwent a brain DTPA-SPECT within 72?h of the first seizure and were compared to a control group of stroke patients without seizures. Twenty-eight patients were included in the study. Twelve out of 14 (85.7%) in the group of seizure post-stroke patients had a positive brain DTPA-SPECT showing disruption of the BBB in the region of the stroke respective to four patients out of 14 (28.6%) in the control group of stroke patients without seizures (p?=?0.001). The results of this study suggest that there is a correlation between late post-stroke seizures and BBB disruption, as revealed by DTPA-SPECT examination. Perhaps, this finding could lead to the hypothesis that the BBB disruption can predict developing seizures in patients with cortical stroke.     

Pathogenesis of epileptic seizures and epilepsy after stroke

Stroke is an important cause of seizures and epilepsy in adults, particularly among the elderly. The incidence of stroke increases yearly as life expectancy increases and the number of patients with post-stroke seizures and epilepsy is also rising. Post-stroke epilepsy accounts for nearly 50% of newly diagnosed epilepsy among patients over 60 years of age. With increasing stroke awareness and advanced treatments, increased attention is paid to post-stroke seizures and epilepsy including its diagnosis and treatment. There has been a plethora of research on the pathogenesis of seizures and epilepsy after stroke. And thus, the research advances in the pathogenesis and related therapeutic targets of post-stroke seizures and epilepsy will be reviewed in this article.     

Predictive factors for the development of epilepsy after ischemic stroke

ObjectivesIschemic stroke is one of the most common causes of epilepsy in adults. The incidence of post-stroke epilepsy (PSE) is approximately 7%. Risk factors are higher stroke severity, cortical localization, higher National Institute of Health Stroke Scale (NIHSS) upon admission and acute symptomatic seizures. We analyzed the predictive factors of PSE development in our population.Materials and methodsRetrospective observational cohort of adult patients (age ≥ 18 years) with ischemic stroke assessed between January 2012 and June 2020. Patients with personal history of epilepsy and potentially epileptogenic structural injury other than acute or chronic stroke were excluded. Demographic, clinical and imaging variables were evaluated in a multivariate analysis for independent risk factors associated with PSE.ResultsMedical records of 1586 stroke patients were reviewed, 691 met the inclusion criteria and had at least one year of follow-up. Of them, 428 (61.9%) were males. During follow-up, 6.2% had diagnosis of PSE (42/691) with a higher frequency of: previous ischemic stroke, higher NIHSS upon admission, treatment with rt-PA, higher Fazekas scale grade, cortical involvement, hemorrhagic transformation, acute symptomatic seizures, longer hospitalization and higher modified Rankin Scale (mRS) at discharge compared to the group without PSE. In a multivariate analysis, acute symptomatic seizures (OR=3.22, p: 0.033), cortical involvement (OR=0.274, p < 0.05), Fazekas scale score (OR=0.519, p < 0.05) and mRS at discharge (OR=1.33, p: 0.043) were independent risk factors.ConclusionsThe variables related to higher risk of PSE were similar to those reported in the literature, highlighting the importance of neuroimaging findings, acute symptomatic seizures during hospitalization and neurological deficit at discharge. The data obtained will serve as the basis for construction of predictive models, allowing to individualize PSE probability in our population.     

The epidemiology of post-stroke epilepsy according to stroke subtypes

OBJECTIVES: Strokes represent the most common etiology of epilepsy in patients over the age of 60 years, with an incidence of 2-4% occurring in different studies. MATERIALS AND METHODS: In this observational study, 1,428 patients were included who had stroke and were admitted to our Stroke Unit between the years 1996 and 2005. RESULTS: Overall, 51 patients had post-stroke epilepsy (3.6%). Post-ischemic epilepsy occurred in 70.6% of the patients, post-hemorrhagic epilepsy occurred in 21.6% of the patients and epilepsy following venous infarctions occurred in 7.8% of all post-stroke epilepsy patients. Of 1,327 patients having ischemic stroke, 36 patients (2.7%), 11 out of 86 patients with hemorrhagic stroke (12.8%) and 4 of 15 patients with venous infarctions (26.6%) developed epilepsy. Compared with stroke patients without epilepsy, hemorrhagic (P<0.001) and venous infarctions were more common in patients with post-stroke epilepsy (P<0.001). The right hemisphere and the middle cerebral artery (MCA) territory were most commonly observed in ischemic and hemorrhagic stroke patients. CONCLUSIONS: Our results indicate that post-stroke epilepsy is more common among patients who have experienced venous infarctions. Hemorrhagic and venous infarctions are more commonly encountered in post-stroke epilepsy patients. Atherosclerotic and cardioembolic strokes were similar to those that occurred in post-stroke epilepsy patients. Localizations in post-stroke epileptic patients showed that the majority occurred in the right hemisphere, in the territory of the MCA. However, prospective, multicentered studies are needed for a better understanding of the epidemiology and social impact of post-stroke epilepsy.     

Predictive value of the Royal Melbourne Hospital Falls Risk Assessment Tool (RMH FRAT) for post-stroke patients

Falls after stroke are common and carry a significant disease burden. Several scores aim to identify patients who are at risk of falls to implement primary prevention therapy. The aim of this study was to determine the validity of the commonly used Falls Risk Assessment Tool (FRAT) developed at the Royal Melbourne Hospital (RMH) in 1995 for predicting falls after a stroke. The RMH FRAT was administered within 2 weeks after discharge post-stroke. Occurrence of falls was recorded at 3 and 6 months post-stroke in 202 and 152 patients, respectively. In our study 90% of patients were placed in the RMH FRAT high risk or medium risk group. In these two groups the RMH FRAT did not provide sufficient predictive value.     

卒中类型、卒中部位与卒中后癫痫的多因素关系

目的探讨卒中类型、卒中部位与卒中后癫痫的多因素关系,为卒中后癫痫的防治提供参考。方法以1804例卒中患者为研究对象,收集其性别、年龄、卒中类型、卒中部位、卒中后癫痫发生的时间等资料,根据卒中后是否发生癫痫,将患者分为卒中后无癫痫组(n=1487)和卒中后癫痫组(n=317),分析卒中后癫痫发作的危险因素。结果共317例卒中后癫痫发作患者,其中早发性癫痫141例(44.48%),迟发性癫痫176例(55.52%)。不同卒中部位及卒中类型的癫痫发病率为17.57%。多因素logistic回归分析显示,卒中部位中的顶叶合并蛛网膜下腔、额叶合并颞叶、额叶合并颞叶和枕叶、单一颞叶是卒中后发生癫痫的危险因素(P<0.01),其中单一颞叶是卒中后早发性癫痫的危险因素(P<0.01)。脑梗死患者常见早发性癫痫(23.66%),脑出血患者常见迟发性癫痫(47.95%)。结论卒中类型中的脑梗死、脑出血、蛛网膜下腔出血与卒中后癫痫有关;卒中部位中顶叶合并蛛网膜下腔、额叶合并颞叶、额叶合并颞叶和枕叶、单一颞叶与卒中后癫痫有关。     

How to diagnose and treat post‐stroke seizures and epilepsy

Stroke is one of the commonest causes of seizures and epilepsy, mainly among the elderly and adults. This seminar paper aims to provide an updated overview of post‐stroke seizures and post‐stroke epilepsy (PSE) and offers clinical guidance to anyone involved in the treatment of patients with seizures and stroke. The distinction between acute symptomatic seizures occurring within seven days from stroke (early seizures) and unprovoked seizures occurring afterwards (late seizures) is crucial regarding their different risks of recurrence. A single late post‐stroke seizure carries a risk of recurrence as high as 71.5% (95% confidence interval: 59.7–81.9) at ten years and is diagnostic of PSE. Several clinical and stroke characteristics are associated with increased risk of post‐stroke seizures and PSE. So far, there is no evidence supporting the administration of antiepileptic drugs as primary prevention, and evidence regarding their use in PSE is scarce.     

Risk assessment of mechanic thrombectomy on post-stroke seizures: a systematical review and meta-analysis

PurposeWe conducted a systematic review and meta-analysis to evaluate the risk of early and late onset seizures following stroke mechanic thrombectomy (MT) compared with other systematic thrombolytic strategies.MethodsA literature search was conducted to identify articles covering databases (PubMed, Embase, and Cochrane Library) published from 2000 to 2022. The primary outcome was the incidence of post-stroke epilepsy or seizures following MT or in combination with intravenous thrombolytics therapy. Risk of bias was assessed by recording study characteristics. The study was conducted according to the PRISMA guidelines.ResultsThere were 1346 papers in the search results, and 13 papers were included in the final review.We identified 29,793 patients with stroke, of which 695 had seizures. Pooled incidence of post-stroke seizures had no significant difference between mechanic thrombolytic group and other thrombolytic strategy group (OR=0.95 (95%CI= 0.75-1.21); Z=0.43; p=0.67). In subgroup analysis, mechanic group have a lower risk of post-stroke early onset of seizures (OR=0.59 (95%CI=0.36-0.95); Z=2.18; p<0.05) but showed no significant difference in post-stroke late onset of seizures (OR=0.95 (95%CI= 0.68-1.32); Z=0.32; p=0.75).ConclusionsMT may be associated with a lower risk of post-stroke early onset of seizures, despite MT does not affect the pooled incidence of post-stroke seizures compared with other systematic thrombolytic strategies.     

Clinical Electroencephalographic Biomarker for Impending Epilepsy in Asymptomatic Tuberous Sclerosis Complex Infants

BackgroundWe assessed the clinical utility of routine electroencephalography (EEG) in the prediction of epilepsy onset in asymptomatic infants with tuberous sclerosis complex.MethodsThis multicenter prospective observational study recruited infants younger than 7 months, seizure-free and on no antiepileptic drugs at enrollment, who all underwent serial physical examinations and video EEGs throughout the study. Parental education on seizure recognition was completed at the time of initial enrollment. Once seizure onset occurred, standard of care was applied, and subjects were followed up until 24 months.ResultsForty patients were enrolled, 28 older than 12 months with completed EEG evaluation at the time of this interim analysis. Of those, 19 (67.8%) developed seizures. Epileptic spasms occurred in 10 (52.6%), focal seizures in five (26.3%), generalized tonic-clonic seizure in one (5.3%), and a combination of epileptic spasms and focal seizures in three (15.7%). Fourteen infants (73.6%) had the first emergence of epileptiform abnormalities on EEG at an average age 4.2 months, preceding seizure onset by a median of 1.9 months. Hypsarrhythmia or modified hypsarrhythmia was not found in any infant before onset of epileptic spasms. All children with epileptiform discharges subsequently developed epilepsy (100% positive predictive value), and the negative predictive value for not developing epilepsy after a normal EEG was 64%.ConclusionsSerial routine EEGs in infants with tuberous sclerosis complex is a feasible strategy to identify individuals at high risk for epilepsy. The most frequent clinical presentation was epileptic spasms followed by focal seizures, and then a combination of both seizure types.     

脑卒中后早期认知功能障碍与远期抑郁症状的Logistic回归分析

目的 研究急性脑卒中患者中认知功能障碍对远期产生抑郁症状(DS)的预测价值.方法 根据入选排除标准选择143例脑卒中后前3周的病人,选择预测变量为早期认知功能、人口基性特征、血管危险因素、病变部位、抑郁症状、神经功能缺损及日常生活能力,因变量为入组后6～10个月后远期抑郁症状(蒙哥马利抑郁量表评分>7分)进行多元Log...     

Seizures after stroke: a prospective multicenter study

BACKGROUND: Studies of seizures after stroke have largely been retrospective, with small patient numbers and limited statistical analysis. Much of the doctrine about seizures after stroke is not evidenced based. OBJECTIVE: To determine the incidence, outcome, and risk factors for seizures after stroke. DESIGN: International, multicenter, prospective, analytic inception cohort study conducted for 34 months. PATIENTS AND SETTING: There were 2021 consecutive patients with acute stroke admitted to university teaching hospitals with established stroke units. After exclusion of 124 patients with previous epilepsy or without computed tomographic diagnosis, 1897 were available for analysis. Mean follow-up was 9 months. MAIN OUTCOME MEASURES: Occurrence of 1 or more seizures after stroke, stroke disability, and death after stroke. RESULTS: Seizures occurred in 168 (8.9%) of 1897 patients with stroke (28 [10.6%] of 265 with hemorrhagic and 140 [8.6%] of 1632 with ischemic stroke). On Kaplan-Meier survival analysis, patients with hemorrhagic stroke were at significantly greater risk of seizures (P =.002), with an almost 2-fold increase in risk of seizure after stroke (hazard ratio [HR], 1.85; 95% confidence interval [CI], 1.26-2.73; P =.002). On multivariate analysis, risk factors for seizures after ischemic stroke were cortical location of infarction (HR, 2.09; 95% CI, 1. 19-3.68; P<.01) and stroke disability (HR, 2.10; 95% CI, 1.16-3.82; P<.02). The only risk factor for seizures after hemorrhagic stroke was cortical location (HR, 3.16; 95% CI, 1.35-7.40; P<.008). Recurrent seizures (epilepsy) occurred in 47 (2.5%) of 1897 patients. Late onset of the first seizure was an independent risk factor for epilepsy after ischemic stroke (HR, 12.37; 95% CI, 4.74-32.32; P<. 001) but not after hemorrhagic stroke. CONCLUSIONS: Seizures occur more commonly with hemorrhagic stroke than with ischemic stroke. Only a small minority later develop epilepsy. Patients with a disabling cortical infarct or a cortical hemorrhage are more likely to have seizures after stroke; those with late-onset seizures are at greater risk of epilepsy.     

卒中后痫性发作及卒中后癫痫研究现状与进展

卒中后痫性发作和卒中后癫痫的定义尚不统一,流行病学研究显示其发生率在卒中患者中 为3%～30%,对卒中患者的预后有一定的影响。针对卒中后痫性发作和卒中后癫痫的治疗有卒中的治 疗和二级预防以及抗癫痫药物治疗,有的研究显示新型抗癫痫药物的治疗效果优于传统药物,他汀 类药物也可能降低其发生率。目前尚缺乏关于卒中后痫性发作和癫痫的诊疗共识或指南,亟待进一步 研究为其提供循证医学证据。     

Frequency and predictors of post-stroke delirium in PRospective Observational POLIsh Study (PROPOLIS)

Delirium is the most common and serious neurobehavioral complication in acute hospital admissions. Some patients develop signs of delirium but do not meet all diagnostic criteria. Stroke is a major risk factor for delirium. The aim of this prospective study was to build a predictive model for delirium and subsyndromal post-stroke delirium. Patients with stroke were screened for delirium during the first 7 days after admission. Delirium was diagnosed according to DSM-V criteria. Baseline demographic, biochemical, stroke-related data, medications used, neurological deficit, and premorbid cognitive and functional impairment were assessed. 750 consecutive stroke patients (71.75 ± 13.13 years) were recruited; 203 (27.07%) had delirium. In predictive model for delirium MoCA score and white blood count on admission, neglect, vision deficits, physical impairment, and higher comorbidity prior to stroke had the highest predictive value. Subsyndromal delirium was diagnosed in 60 patients. MoCA score and potassium level on admission, and urinary tract infection during hospitalization had the highest predictive value for its development. Delirium occurs in one-fourth of admissions due to stroke; subsyndromal delirium is less prevalent and affects less than one per ten patients. The hyperactive form is the most rare type of delirium. The factors best predicting delirium are easily assessed in everyday practice and their co-occurrence in patients with stroke should alert the treating physician of high risk of delirium.     

Epileptic seizure after stroke in Chinese patients

This was a hospital-based cohort study aiming at determining the occurrence rate of post-stroke seizures and the associated risk factors. From 27 July 1996 to 16 June 1998, the first 1000 consecutive patients in the acute stroke registry were retrospectively reviewed for one year after acute stroke to identify seizure occurrence. The demographic data, seizure onset time, seizure type, drug treatment, response to medication, electroencephalogram findings and cranial computed tomogram findings were collected. Thirty-four patients (3.4%) developed seizure within one year after acute stroke. Univariate analysis revealed that male, age greater than 65 years, total anterior circulation infarction, partial anterior circulation infarction, cortical location and large lesion were significantly associated with post-stroke seizure while multivariate analysis showed that only male (adjusted OR 3.21, p<0.01) and cortical location (adjusted OR 3.83, p<0.05) were significant independent risk factors. Fifty-six percent of early seizures were partial type whereas 72% of late seizures were generalized tonic-clonic type of undetermined onset. Seizures occurred in 3.4% of patients within one year after the onset of stroke. This percentage of seizure occurrence and associated risk factors were similar to other studies. However, intracerebral and subarachnoid haemorrhage were not shown to be risk factors in our study.     

Incidence and risk factors for seizures after heart transplantation

Neurological complications can occur after heart transplantation and present with seizures. We examined the incidence of seizures from a population of adult patients who had received heart transplants over a period of 3 years. Brain MRI and clinical data were analysed to identify the risk factors for the seizures. Eight of the 166 post-transplant patients presented seizures (4.8%). The first seizures occurred with a mean of 30 days after the transplantation. For seven patients, the mean delay was 8 days, and for one, it was longer, 172 days. The analysis of brain MRI showed two main epileptogenic factors in the early post-transplant seizures: posterior reversible encephalopathy syndrome (PRES) due to cyclosporine treatment (n = 4) and cortical ischemic stroke (n = 5). In two patients, we identified multiple epileptogenic factors, including notably the association of PRES and cortical stroke. Since treatment of seizures in patients in the intensive care unit (ICU) after heart transplantation depends on identifying and correcting the causes, FLAIR and diffusion MRI sequences are needed, even if the patients have a previous history of epilepsy. Seizures were easy to control. In patients with PRES, imaging and clinical abnormalities improved when cyclosporine was replaced by another immunosuppressive treatment. Death of three patients was not related to seizures, but to infectious or malignant complications of immunosuppressive treatments (n = 2) or to post-stroke neurological deficit (n = 1). Mortality was similar among patients presenting seizures and those who did not.