Early seizures in stroke – frequency,risk factors,and effect on patient outcomes in a tertiary center in Saudi Arabia

Objectives:To determine the frequency, risk factors, and outcomes of Early seizure (ES) after stroke in a Saudi cohort.Methods:A retrospective study was conducted in King Abdulaziz Medical City, Riyadh, KSA. All stroke patients whether they had first or recurrent stroke were included from February 2016 to December 2017. Data were analyzed using the SAS software version 9.4.Results:Out of 665 patients, 456 (68.6%) were males and 564 (85.2%) were Saudis; the cohort’s mean age was 60.6±12.6 years. Fifty-one (7.7%) patients had ES, which were more common in women (p=0.0123). Loss of consciousness (p=0.0402) and confusion (<0.0007) were associated with ES, whereas unilateral weakness (p=0.001) and unilateral numbness (p=0.0317) at presentation decreased the risk of ES. Vascular risk factors did not differ between patients with and without ES. Hemorrhagic stroke was associated with ES (p=0.0054), whereas patients with small vessel disease were less likely to develop ES (p=0.0013). Patients with ES had more severe stroke (NIHSS >5) (p=0.0139), more ICU admissions (49% vs. 26.2%; p=0.0005), longer length of hospital stay (44.9 days vs. 24.9 days; p=0.0018), higher rates of stroke-related complications (e.g. recurrent stroke, pulmonary embolism, hospital acquired infections, and need for tracheostomy and gastrostomy tube placement) (p≤0.0001), and were likely to be more severely disabled defined as mRS 3–5 at discharge (47.7% vs. 40.8%; p=0.0055) or to die in hospital (11.8% vs. 4.6%; p≤0.0001).Conclusion:The ES after stroke were common in our cohort. Increased stroke severity and confusion were independent predictors of ES. The ES were associated with higher rates of in-hospital complications, longer length of hospital stay, and worse outcomes at discharge.

Stroke is one of the common causes of symptomatic seizures in the elderly. Post-stroke seizures (PSS) are commonly classified into early seizures (ES) and late seizures (LS). ¹ No specific cut-off point that delineates ES has been agreed upon, but most studies arbitrarily define ES as those that occur within 7–14 days of incident stroke. ^1-2 The PSS occurring beyond this period are considered LS. The incidence rate for ES after stroke is not well established, although it has been reported to be 2%–33%. ^2,3 A recent meta-analysis has found that ES incidence after ischemic stroke is 3.3%, whereas the LS incidence rate was found to be 18 per 1000 person-years. ¹ A study investigating seizures that occurred within 24 h of stroke onset has found an incidence of 3.1% in more than 6,000 stroke patients. ³ Not all patients with PSS develop epilepsy. Approximately 2-4% of patients develop epilepsy after stroke. ⁴ Data on the risk factors for ES after stroke are inconsistent. In some studies, cardioembolic stroke, cortical location of stroke, hemorrhagic transformation of ischemic stroke, increased severity of stroke, and history of coronary artery disease or atrial fibrillation were found to be the predictors of ES after stroke. ^2,4-5 The ES after stroke are associated with increased morbidity and mortality, and can affect the functional independence of stroke patients, resulting in poorer quality of life, as well as in increased resource utilization. ^3-6 However, evidence-based data on PSS and guidelines on PSS management remain lacking. ⁶ The PSS are not uncommon and are broadly classified into ES and LS. Not all patients with ES develop post-stroke epilepsy. ⁶ The pathophysiological mechanisms underlying ES and LS are widely different. Having a specific time window to define ES from LS is crucial, as this may help in predicting post-stroke epilepsy. In the acute phase of stroke, ionic shifts, excitotoxicity neurotransmitters, metabolic dysfunction, and changes in coagulation cascade can all contribute to the early onset of seizure after an ischemic event. ^7-8 By contrast, LS results from persistent structural changes and gliosis that occur in the late phase of stroke, causing disruption in neuronal firing, circuit dysfunction, and eventually epileptogenic changes. ^7-8 The PSS has been studied in different populations; considering the observed variations in incidence, risk factors, and outcomes of PSS, we find it important to investigate this condition in the Saudi population. Our study aimed to determine the frequency of post stroke seizures in our population, and to identify the predictors of ES. It also looked at the outcome of these patients. To the best of our knowledge, this is the earliest study to report data on ES after stroke in a Saudi cohort, and it may be useful in planning future large-scale studies on ES prevention and management.     

Synthesis and Comparison of Linear Polymannosides for Direct Binding with Escherichia coli

Here, the synthesis of linear polyglycerols bearing multiple copies of mono and dimannosides (LPG₄₀Man_0.60 and LPG₄₀(Manα1,2Man)_0.60) is demonstrated. A method based on label-free microscale thermophoresis is optimized to determine the direct binding affinity of multivalent mannosides for Escherichia coli (E. coli) strain ORN178 that produces the fimbriae protein FimH. It is observed that the LPG₄₀(Manα1,2Man)_0.60 exhibits only a modest onefold improvement in binding as compared to LPG₄₀Man_0.60. Nevertheless, both the multivalent mannosides display remarkably very low nm binding constant (K_d) in contrast to the high µm K_d of the single α-d -methylmannoside for intact E. coli ORN178 particles. Furthermore, in an adhesion-inhibition assay, both multivalent mannosides show 50% inhibition of bacteria adhesion to the HT-29 colon cells at low µm concentrations.