Antiseizure medications for post‐stroke epilepsy: A real‐world prospective cohort study

Fukuma, Kazuki; Abe, Soichiro; Matsubara, Soichiro; Motoyama, Rie; Mizobuchi, Masahiro; Yoshimura, Hajime; Matsuki, Takayuki; Manabe, Yasuhiro; Suzuki, Junichiro; Ikeda, Shuhei; Kamogawa, Naruhiko; Ishiyama, Hiroyuki; Kobayashi, Katsuya; Shimotake, Akihiro; Nishimura, Kunihiro; Onozuka, Daisuke; Koga, Masatoshi; Toyoda, Kazunori; Murayama, Shigeo; Matsumoto, Riki; Takahashi, Ryōsuke; Ito, Akio; Ihara, Masafumi; Investigators, Propose Study

doi:10.1002/brb3.2330

Cited by 25 publications

(27 citation statements)

References 43 publications

(75 reference statements)

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“…Also, indirect comparisons of LEV and LTG did not reveal differences in seizure freedom (odds ratio 0.86; 95% CI: 0.15.− 4.89) [10]. However, significantly lower mortality was seen with LTG monotherapy compared to therapy with CBZ [18] and overall, therapy with newer ASMs showed better seizure control and better tolerability compared with older ASMs [19].…”

Section: Discussionmentioning

confidence: 91%

Efficacy and safety of antiseizure medication in post-stroke epilepsy

Winter

Uphaus

Sandner

et al. 2022

Seizure: European Journal of Epilepsy

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Section: Discussionmentioning

confidence: 91%

Efficacy and safety of antiseizure medication in post-stroke epilepsy

Winter

Uphaus

Sandner

et al. 2022

Seizure: European Journal of Epilepsy

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“…This study was conducted as a single-center sub-analysis of the PROgnosis of Post-Stroke Epilepsy (PROPOSE) study (UMIN000019940), consisting of (i) a preceding single-center retrospective cohort in the National Cerebral and Cardiovascular Center (NCVC) between January 2011 and October 2014 and (ii) a multi-center (eight sites) prospective cohort between November 2014 and September 2018 ( 3 ). PROPOSE was a non-interventional observational cohort study, enrolling patients with PSE admitted to each stroke center.…”

Section: Methodsmentioning

confidence: 99%

“…Poststroke epilepsy (PSE) is the most common type of epilepsy in the elderly ( 1 ) and is related to poor prognosis in poststroke survivors ( 2 ). Diagnosis of PSE is often challenging in cases which present with non-convulsive seizures and show no epileptiform abnormalities on electroencephalography (EEG) ( 3 ). Our recent study identified prolonged postictal hyperperfusion in PSE using postictal-interictal (P-I) subtraction perfusion single-photon emission computed tomography (SPECT) co-registered to magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

Developing an Asymmetry Method for Detecting Postictal Hyperperfusion in Poststroke Epilepsy

Fukuma

Takaya²,

Tojima

et al. 2022

Front. Neurol.

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Using dual single-photon emission computed tomography (SPECT) scanning, we recently found the postictal-interictal (P-I) subtraction method frequently detects prolonged postictal hyperperfusion in poststroke epilepsy (PSE) and thus may be valuable for auxiliary diagnosis. This study aimed to determine if the asymmetry method can localize hyperperfusion to reflect epileptic activity in PSE using a single postictal SPECT scan. Sixty-four patients with PSE who had undergone perfusion SPECT two times (postictal and interictal) were enrolled. We formulated a novel asymmetry method (subtraction analysis of reversed postictal SPECT from postictal SPECT, co-registered to magnetic resonance imaging) to identify paradoxical asymmetric increase, defined as a higher perfusion area adjacent to stroke lesions compared to the contralateral side. The postictal hyperperfusion area and detection rates were determined by the asymmetry and P-I subtraction methods independently. We subsequently calculated the sensitivity and specificity of the asymmetry method, compared to the gold standard P-I subtraction method. We also evaluated lateralization concordance between the asymmetry method and other clinical findings. Among 64 patients (median age, 75 years), prolonged postictal hyperperfusion was detected in 43 (67%) by the asymmetry, and 54 (84%) the P-I, method. The asymmetry method had high sensitivity (80%) and specificity (100%) in detecting postictal hyperperfusion, showing high lateralization concordance with seizure semiology (97%) and epileptiform electroencephalography findings (interictal/ictal epileptiform discharges or periodic discharges) (100%). The present study demonstrated the advantages of the objective asymmetry method for detecting prolonged hyperperfusion through using one postictal SPECT scan in PSE.

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“…All PSE diagnoses were made by board-certified epileptologists or neurologists at each institution based on the seizure semiology, EEG findings, and brain imaging findings (CT, MRI, and/or SPECT). 11 Among patients with PSE enrolled in the PROPOSE study, this study only included patients with a first-ever seizure to ensure a uniform duration between the onset and outcome assessments.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Impact of Seizure Recurrence on 1-Year Functional Outcome and Mortality in Patients With Poststroke Epilepsy

et al. 2022

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Background and Objectives:The functional outcome and mortality of post-stroke epilepsy (PSE) patients have not been assessed in a prospective study. Previous reports have suggested that PSE patients may suffer from prolonged functional deterioration following a seizure. In the current study, we prospectively investigated the functional outcome and mortality of PSE patients and analyzed the impact of seizure recurrence on the outcomes.Methods:This is part of the Prognosis of Post-Stroke Epilepsy (PROPOSE) study, a multicenter, prospective observational cohort study, where 392 PSE patients (at least one unprovoked seizure more than 7 days after the onset of the last symptomatic stroke) were followed for at least 1 year at eight hospitals in Japan. The current study included only PSE patients with a first-ever seizure and assessed their functional decline and mortality at 1 year. Functional decline was defined as an increase in modified Rankin Scale (mRS) score at 1 year compared to baseline, excluding death. The associations between seizure recurrence and the outcomes were analyzed statistically.Results:A total of 211 patients (median age of 75 years; median mRS score of 3) were identified. At 1 year, 50 patients (23.7%) experienced seizure recurrence. Regarding outcomes, 25 patients (11.8%) demonstrated functional decline, and 20 (9.5%) had died. Most patients died of pneumonia or cardiac disease (seven patients each), and no known causes of death were directly related to recurrent seizures. Seizure recurrence was significantly associated with functional decline (odds ratio 2.96 [95% CI 1.25–7.03], P=0.01), even after adjusting for potential confounders (adjusted odds ratio 3.26 [95% CI 1.27–8.36], P=0.01), but not with mortality (odds ratio 0.79 [95% CI 0.18–2.61], P=0.79). Moreover, there was a significant trend where patients with more recurrent seizures were more likely to have functional decline (8.7%, 20.6%, and 28.6% in none, 1, and 2 or more recurrent seizures, respectively; P=0.006).Discussion:One-year functional outcome and mortality of PSE patients were poor. Seizure recurrence was significantly associated with functional outcome, but not with mortality. Further studies are needed to ascertain whether early and adequate anti-seizure treatment can prevent the functional deterioration of PSE patients.

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Antiseizure medications for post‐stroke epilepsy: A real‐world prospective cohort study

Cited by 25 publications

References 43 publications

Efficacy and safety of antiseizure medication in post-stroke epilepsy

Efficacy and safety of antiseizure medication in post-stroke epilepsy

Developing an Asymmetry Method for Detecting Postictal Hyperperfusion in Poststroke Epilepsy

Impact of Seizure Recurrence on 1-Year Functional Outcome and Mortality in Patients With Poststroke Epilepsy

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