Acute symptomatic seizures and epilepsy after mechanical thrombectomy

Abstract

To assess the incidence of acute symptomatic seizures and post-stroke epilepsy (PSE) in a well-characterized cohort of patients treated with mechanical thrombectomy. In addition, we aimed to describe the dynamics of blood markers of brain injury in patients that developed PSE. Methods: Participants of the prospective AnStroke Trial of anesthesia method during mechanical thrombectomy were included and acute symptomatic seizures and PSE ascertained by medical records review. Blood markers NFL, tau, GFAP, S100B, and NSE were assessed. Results: A total of 90 patients with acute anterior ischemic stroke were included. Median NIHSS at admission to hospital was 18 (IQR 15-22). Recanalization was achieved in 90%. No patients had epilepsy prior to the ischemic stroke. Four patients (4.4%) had acute symptomatic seizures and four patients (4.4%) developed PSE during the follow-up time (to death or last medical records review) of 0-4.5 years (median follow-up 1070 days IQR 777-1306), resulting in a two-year estimated PSE risk of 5.3% (95%CI: 0.2-10.4%). Blood markers of brain injury (NFL, tau, GFAP, S100B, and NSE) were generally above the cohort median in patients that developed PSE. Conclusions: The incidence of PSE after mechanical thrombectomy was low in our cohort. All blood biomarkers displayed interesting sensitivity and specificity. However, the number of PSE cases was small and more studies are needed on risk factors for PSE after mechanical thrombectomy. The potential of blood markers of brain injury markers to contribute to assessment of PSE risk should be explored further.

Blood biomarkers predictive of epilepsy after an acute stroke event

“…In line with literature, the prevalence of stroke‐related epilepsy was almost 6%, and it occurred more often in patients with higher NIHSS scores and a history of early onset seizures 6,2 . Approximately 7% of the patients who underwent reperfusion treatment developed poststroke epilepsy, similar to earlier studies in which incidence ranged between 4% and 16.7% 15,20,21 . In our study, because cortical involvement was strongly associated with stroke severity (NIHSS), no significant results were found after performing a multiple regression analysis.…”

“…6,2 Approximately 7% of the patients who underwent reperfusion treatment developed poststroke epilepsy, similar to earlier studies in which incidence ranged between 4% and 16.7%. 15,20,21 In our study, because cortical involvement was strongly associated with stroke severity (NIHSS), no significant results were found after performing a multiple regression analysis. Of note, mortality rate was up to 41% in accordance with long-term mortality studies that reported mortality rates up to 72%; 22 thus, our mortality rate is that expected in the long term.…”

“…12,13 Our group found an association between early poststroke seizures and higher neural cell adhesion molecule (NCAM) levels and lower tumor necrosis factor (TNF)-R1 levels. 14 Recently, the group of Zelano investigated the dynamics of blood markers in early onset seizures and epilepsy after mechanical thrombectomy 15 . Nonetheless, the current understanding of brain inflammation and whether these molecules are involved in stroke-related epilepsy is still limited.…”

Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke

“…In addition, the vast majority of these studies only investigated IVT therapy, reporting a risk for acute symptomatic seizures after rt-PA treatment between 1-4%. Only a few studies have investigated the effect of MT on the frequency of acute symptomatic seizures 23,[31][32][33] .…”

Advances in the Development of Biomarkers for Poststroke Epilepsy

“…With a sensitivity of predicting poststroke epilepsy being 100%, the best specificity can still reach 77%~93%. However, given the low incidence of poststroke epilepsy in this study, statistical analysis was not further performed [63]. Recent meta-analyses of several cohorts provide a multitude of evidence that support the elevation of S100B protein level in epilepsy patients.…”