Poststroke epilepsy in long-term survivors of primary intracerebral hemorrhage

Lahti, Anna-Maija; Saloheimo, Pertti; Huhtakangas, Juha; Salminen, Henrik; Juvela, Seppo; Bode, Michaela K.; Hillbom, Matti; Tetri, Sami

doi:10.1212/wnl.0000000000004009

Cited by 75 publications

(78 citation statements)

References 39 publications

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“…In a population‐based study, those with ESs were about 16 times more likely to develop epilepsy as compared with those without ESs . Similarly, in a recent study of 615 patients with primary intracerebral hemorrhage (ICH), subcortical hematoma location and ESs increased the risk of STRE, whereas hypertension seemed to reduce the risk .…”

Section: Epidemiologymentioning

confidence: 96%

Stroke‐related epilepsy

Feyissa

Hasan

Meschia

2018

Euro J of Neurology

119

120

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Stroke is the cause of about 10% of all epilepsy and 55% of newly diagnosed seizures among the elderly. Although recent advances in acute stroke therapy have improved longevity, there has been a consequent rise in the prevalence of stroke-related epilepsy (STRE). Many clinical studies make a distinction between early (within 7 days of onset of stroke) and late (beyond 7 days of onset of stroke) seizures based on presumed pathophysiological differences. Although early seizures are thought to be the consequence of local metabolic disturbances without altered neuronal networks, late seizures are thought to occur when the brain has acquired a predisposition for seizures. Overall, STRE has a good prognosis, being well controlled by antiepileptic drugs. However, up to 25% of cases become drug resistant. STRE can also result in increased morbidity, longer hospitalization, greater disability at discharge and greater resource utilization. Additional controlled trials are needed to explore the primary and secondary prevention of STRE as well as to provide highquality evidence on efficacy and tolerability of antiepileptic drugs to guide treatment of STRE. Robust pre-clinical and clinical prediction models of STRE are also needed to develop treatments to prevent the transformation of infarcted tissue into an epileptic focus.

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Section: Epidemiologymentioning

confidence: 96%

Stroke‐related epilepsy

Feyissa

Hasan

Meschia

2018

Euro J of Neurology

119

120

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“…Stroke causes 14-21% of epilepsy and is the leading cause of epilepsy after middle age [1]. Poststroke epilepsy (PSE) complicates at least 6% of infarctions and 12% of ICH, respectively [2][3][4]. Specific evidence to guide treatment of PSE is surprisingly scarce.…”

Section: Introductionmentioning

confidence: 99%

Retention rate of first antiepileptic drug in poststroke epilepsy: A nationwide study

Larsson

Åsberg

Kumlien

et al. 2019

Seizure

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A B S T R A C TPurpose: To describe the retention rates of first antiepileptic drugs (AEDs) in patients with poststroke epilepsy on a nationwide scale. Methods: The Swedish Stroke Register, which has 94% coverage and high-resolution data on stroke, comorbidities, and disability, was cross-referenced to the National Patient Register, Drug Register, and Cause-of-Death Register. Patients with onset of AED-treated epilepsy after stroke in 2005-2010 were included. An algorithm based on prescription renewal intervals was used to analyze treatment data until the end of 2014. Results: A total of 4991 patients were included. First AEDs analyzed were carbamazepine (n = 2373), valproic acid (n = 943), levetiracetam (n = 555), lamotrigine (n = 519), phenytoin (n = 176), and oxcarbazepine (n = 89). The five-year retention rate was highest for lamotrigine (75%, 95%CI:70.4-79.4), followed by levetiracetam (69%, 95%CI:62.9-74.3), oxcarbazepine (68%, 95%CI:55.2-79.8), valproic acid (62%, 95%CI:57.8-66.4), carbamazepine (60%, 95%CI:57.6-62.4), and phenytoin (55%, 95%CI:45.2-64.0). There were minor differences in baseline characteristics with low levels of disability being slightly more common in patients treated with lamotrigine and levetiracetam. Atrial fibrillation and hypertension were more common in patients treated with levetiracetam, and atrial fibrillation was less common in patients treated with carbamazepine. In a Cox model adjusted for baseline characteristics, the risk of discontinuation was lower for lamotrigine (HR 0.53, 95%CI:0.43-0.67) and levetiracetam (HR 0.75, 95%CI:0.60-0.94) when compared to carbamazepine. Conclusions: Lamotrigine and levetiracetam have higher retention rates than carbamazepine in poststroke epilepsy. This is in agreement with existing small RCTs in this patient group. Material and methods Study design and study cohortThis was a retrospective cohort study based on nation-wide registers. The cohort was selected from patients registered in the Swedish Stroke Register (Riksstroke) between 2005-2010, based on information https://doi.

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“…Another study reported baseline National Institutes of Health Stroke Scale (NIHSS) ≥14 versus <14 to have the strongest association with poor HRQoL 3 months after ICH. Also older age, use of antithrombotics, larger and deep ICH, intraventricular hemorrhage (IVH), early worsening of the neurological deficit, and completion of the questionnaire by proxy responder associated with worse HRQoL (Christensen et al, ; Faught et al, ; Lahti et al, ). Hence, these parameters are associated mostly with the severity of the index ICH.…”

Section: Introductionmentioning

confidence: 99%

“…The most important etiological factor to control after ICH is hypertension; however, no ICH specific secondary preventive medications exist to date (Veltkamp & Purrucker, 2017). Seizures are more common after ICH than ischemic stroke (Christensen, Mayer, Ferran, & Kissela, 2009;Faught, Peters, Bartolucci, Moore, & Miller, 1989;Lahti et al, 2017). Such stroke sequelae and lack of effective secondary prevention can feel burdensome to the patient and caregivers, and affect their quality of life.…”

Section: Introductionmentioning

confidence: 99%

Quality of life and depression 3 months after intracerebral hemorrhage

2019

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Objectives Quality of life (QoL) after intracerebral hemorrhage (ICH) is poorly known. This study investigated factors affecting QoL and depression after spontaneous ICH. Materials and Methods This prospective study included patients admitted to Helsinki University Hospital between May 2014 and December 2016. Health‐related QoL (HRQoL) at 3 months after ICH was measured using the European Quality of Life Scale (EQ‐5D‐5L), and the 15D scale. Logistic regression analyses were used to test factors affecting HRQoL. EQ‐5D‐5L anxiety/depression dimension was used to analyze factors associated with anxiety/depression. Results Of 277 patients, 220 were alive, and sent QoL questionnaire. The questionnaire was returned by 124 patients. Nonreturners had more severe strokes with admission National Institutes of Health Stroke Scale (NIHSS) 7.8 (IQR 3.0–14.8) versus 5.0 (IQR 2.3–11.0); p = 0.018, and worse outcome assessed as modified Rankin Scale 3–5 at 3 months 59.4% versus 44.4% ( p = 0.030). Predictors for lower HRQoL by both scales were higher NIHSS with OR 1.28 (95% CI 1.13–1.46) for EQ‐5D‐5L, and OR 1.28 (1.15–1.44) for 15D, older age (OR 1.10 [1.03–1.16], and OR 1.09 [1.03–1.15]), and chronic heart failure (OR 18.12 [1.73–189.27], and OR 12.84 [1.31–126.32]), respectively. Feeling sad/depressed for more than 2 weeks during the year prior to ICH was predictor for lower EQ‐5D‐5L (OR 10.64 [2.39–47.28]), and history of ICH for lower 15D utility indexes (OR 11.85 [1.01–138.90]). Prior feelings of sadness/depression were associated with depression/anxiety at 3 months after ICH with OR 3.62 (1.14–11.45). Conclusions In this cohort of ICH patients with milder deficits, HRQoL was affected by stroke severity, comorbidities and age. Feelings of depression before ICH had stronger influence on reporting depression/anxiety after ICH than stroke severity‐related and outcome parameters. Thus, simple questions on patient's premorbid feelings of sadness/depression could be used to identify patients at risk of depression after ICH for focusing follow‐up and treatment.

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Poststroke epilepsy in long-term survivors of primary intracerebral hemorrhage

Abstract: Subcortical hematoma location and early seizures increased the risk of PSE after PICH in long-term survivors, while hypertension seemed to reduce the risk.

Cited by 75 publications

References 39 publications

Stroke‐related epilepsy

Stroke‐related epilepsy

Retention rate of first antiepileptic drug in poststroke epilepsy: A nationwide study

Quality of life and depression 3 months after intracerebral hemorrhage

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