Frequency, determinants, and effects of early seizures after thrombolysis for acute ischemic stroke

Xu, Ying; Hackett, Maree L.; Chalmers, John; Lindley, Richard I; Wang, Xia; Li, Qiang; Robinson, Thompson G.; Arima, Hisatomi; Lavados, Pablo M.; Anderson, Craig S.

doi:10.1212/cpj.0000000000000384

Cited by 19 publications

(23 citation statements)

References 29 publications

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“…In spite of earlier evidences that seizures might be a sign of successful reperfusion (30,37), some authors suggest that patients who showed seizures after thrombolysis might present worst thrombolysis outcome when compared to patients without seizures (10,32). In this venue, our results are in line with ENCHANTED trial that showed that seizures after stroke are associated with poor outcome (73). Since studies in post-stroke epilepsy after thrombolysis are few, recent, retrospective in design, and evaluate a relatively small number of patients, their findings need further confirmation.…”

Section: Discussionsupporting

confidence: 80%

Risk Factors for Epilepsy After Thrombolysis for Ischemic Stroke: A Cohort Study

et al. 2020

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= 1.03; 95% CI = 1.01-1.06; p = 0.011), higher NIHSS (OR = 1.08; 95% CI = 1.03-1.14; p = 0.001), hemorrhagic transformation (OR = 2.33; 95% CI = 1.11-4.76; p = 0.024), seizures (OR = 3.07; 95% CI = 1.22-7.75; p = 0.018) and large cortical area (ASPECTS ≤ 7) (OR = 2.04; 95% CI = 1.04-3.84; p = 0.036). Concluding, in this retrospective cohort study, the neurological impairment after thrombolysis (but not before) and hemorrhagic transformation remained independent risk factors for seizures or post-stroke epilepsy after thrombolysis. Moreover, we observed that seizures emerged as an independent risk factor for poor outcome after thrombolysis therapy in stroke patients (OR = 3.07; 95% CI = 1.22-7.75; p = 0.018).

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Section: Discussionsupporting

confidence: 80%

Risk Factors for Epilepsy After Thrombolysis for Ischemic Stroke: A Cohort Study

et al. 2020

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“…However, the fact that SaO did not independently predict poor outcome after accounting for these confounders indicates that it should be considered as a marker for an unfavorable risk profile rather than a predictor for poor outcome per se. This is in line with previous reports on early poststroke seizures being associated with unfavorable baseline risk factors, including higher stroke severity 30,32,[38][39][40][41][42] and higher admission blood glucose. 40,41 Larger, nonlacunar supratentorial infarcts with cortical involvement 31,38,39,[41][42][43] and a potential neurotoxic, epileptogenic effect of hyperglycemia 40,41 might explain these associations.…”

Section: Discussionsupporting

confidence: 93%

“…According to all these reports, early seizures indicated a poor prognosis. [30][31][32] However, SaO-patients were only a small minority, accounting for 3 out of >3,000 IVT-treated patients in the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) trial, 30 1 out of 12 thrombolyzed stroke patients with an early seizure, 31 and 7 out of 800 stroke patients receiving endovascular therapy. 32 Thus, putting our observations in the context of the aforementioned studies, SaO should be distinguished from early seizures, as they seem to differ with regard to prognosis after IVT-treatment.…”

Section: Discussionmentioning

confidence: 99%

Intravenous thrombolysis for suspected ischemic stroke with seizure at onset

Polymeris

Curtze

Erdur

et al. 2019

Annals of Neurology

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for the TRISP CollaboratorsObjective: Seizure at onset (SaO) has been considered a relative contraindication for intravenous thrombolysis (IVT) in patients with acute ischemic stroke, although this appraisal is not evidence based. Here, we investigated the prognostic significance of SaO in patients treated with IVT for suspected ischemic stroke. Methods: In this multicenter, IVT-registry-based study we assessed the association between SaO and symptomatic intracranial hemorrhage (sICH, European Cooperative Acute Stroke Study II definition), 3-month mortality, and 3-month functional outcome on the modified Rankin Scale (mRS) using unadjusted and adjusted logistic regression, coarsened exact matching, and inverse probability weighted analyses. Results: Among 10,074 IVT-treated patients, 146 (1.5%) had SaO. SaO patients had significantly higher National Institutes of Health Stroke Scale score and glucose on admission, and more often female sex, prior stroke, and prior functional dependence than non-SaO patients. In unadjusted analysis, they had generally less favorable outcomes. After controlling for confounders in adjusted, matched, and weighted analyses, all associations between SaO and any of the outcomes disappeared, including sICH (odds ratio [OR] unadjusted = 1.53 [95% confidence interval (CI) = 0.74-3.14], OR adjusted = 0.52 [95% CI = 0.13-2.16], OR matched = 0.68 [95% CI = 0.15-3.03], OR weighted = 0.95 [95% CI = 0.39-2.32]), mortality (OR unadjusted = 1.49 [95% CI = 1.00-2.24], OR adjusted = 0.98 [95% CI = 0.5-1.92], OR matched = 1.13 [95% View this article online at wileyonlinelibrary.com.

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“…The ENCHANTED study identified febrile temperatures as a risk factor for acute seizures 26 , while a Norwegian register study found a relationship between NIHSS score, acute infection, and acute seizures 17 . Our study confirms several previously reported risk factors for acute symptomatic seizures such as more severe stroke and lower functional status at admission 6,16,17 .…”

Section: Discussionmentioning

confidence: 99%

National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases

Zöllner

Misselwitz²,

Kaps

et al. 2020

Sci Rep

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the national institutes of Health Stroke Scale (niHSS) score is the most frequently used score worldwide for assessing the clinical severity of a stroke. prior research suggested an association between acute symptomatic seizures after stroke and poorer outcome. We determined the frequency of acute seizures after ischemic stroke in a large population-based registry in a central european region between 2004 and 2016 and identified risk factors for acute seizures in univariate and multivariate analyses. Additionally, we determined the influence of seizures on morbidity and mortality in a matched case-control design. Our analysis of 135,117 cases demonstrated a seizure frequency of 1.3%. Seizure risk was 0.6% with an NIHSS score at admission <3 points and increased up to 7.0% with >31 score points. Seizure risk was significantly higher in the presence of acute non-neurological infections (odds ratio: 3.4; 95% confidence interval: 2.8-4.1). A lower premorbid functional level also significantly increased seizure risk (OR: 1.7; 95%CI: 1.4-2.0). Mortality in patients with acute symptomatic seizures was almost doubled when compared to controls matched for age, gender, and stroke severity. Acute symptomatic seizures increase morbidity and mortality in ischemic stroke. their odds increase with a higher niHSS score at admission. Ischemic stroke has long been recognized as one of the major risk factors for the development of structural epilepsy, particularly among the elderly 1. In the elderly population, strokes may represent a cause of epilepsy in more than 30% of cases 2,3. Epileptic seizures can occur early (known as acute symptomatic seizures) or late after a stroke, with the threshold usually set at seven days 4. Between 1.1% and 10% of stroke patients end up suffering from acute symptomatic seizures, while 3% to 25.2% develop poststroke epilepsy 1,5-12. While the occurrence of acute symptomatic seizures during the stroke episode can predict the occurrence of poststroke epilepsy 13 , late seizures in patients with a structural lesion due to the stroke by definition result in the diagnosis of epilepsy 6,14 .

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Frequency, determinants, and effects of early seizures after thrombolysis for acute ischemic stroke

Abstract: NCT01422616.

Cited by 19 publications

References 29 publications

Risk Factors for Epilepsy After Thrombolysis for Ischemic Stroke: A Cohort Study

Risk Factors for Epilepsy After Thrombolysis for Ischemic Stroke: A Cohort Study

Intravenous thrombolysis for suspected ischemic stroke with seizure at onset

National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases

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