Early post-acute stroke seizures: Clinical profile and outcome in a Nigerian stroke unit

Aiwansoba, Imarhiagbe Frank; Chukwuyem, Ordia Wallace

doi:10.4103/1596-3519.126936

Cited by 15 publications

(24 citation statements)

References 14 publications

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“…Goswami et al 45 Alcoholism, HS, cortical location, severe stroke Not reported Hypertension, alcoholism, ES, and hemorrhagic stroke predicted early disability or death Aiwansoba et al 46 More frequent in IS Not reported -Pezzini et al 47 Stroke severity on admission, cortical involvement, stroke subtype Twelve studies covering 188 patients including four case reports and eight single-center studies reported CTP changes in seizures 14,59,[81][82][83][84][85][86][87][88][89][90] (Table 6). Their results are relatively homonymous: focal hypo-or hyperperfusion or large hemispheral hypo -or hyperperfusion (usually sparing the basal ganglia) in atypical vessel pattern/ non-corresponding vessel distribution could be detected.…”

Section: Not Reported -mentioning

confidence: 99%

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Early seizures after ischemic stroke: focus on thrombolysis

et al. 2019

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Introduction.Stroke is a significant underlying cause of epilepsy. Seizures due to ischemic stroke (IS) are generally categorized into early seizures (ESs) and late seizures (LSs). Seizures in thrombolysis situations may raise the possibility of other etiology than IS.Aim.We overtook a systematic review focusing on the pathogenesis, prevalence, risk factors, detection, management, and clinical outcome of ESs in IS and in stroke/thrombolysis situations. We also collected articles focusing on the association of recombinant tissue-type plasminogen activator (rt-PA) treatment and epileptic seizures.Results.We have identified 37 studies with 36,775 participants. ES rate was 3.8% overall in patients with IS with geographical differences. Cortical involvement, severe stroke, hemorrhagic transformation, age (<65 years), large lesion, and atrial fibrillation were the most important risk factors. Sixty-one percent of ESs were partial and 39% were general. Status epilepticus (SE) occurred in 16.3%. 73.6% had an onset within 24 h and 40% may present at the onset of stroke syndrome. Based on EEG findings seizure-like activity could be detected only in approximately 18% of ES patients. MRI diffusion-weighted imaging and multimodal brain imaging may help in the differentiation of ischemia vs. seizure. There are no specific recommendations with regard to the treatment of ES.Conclusion.ESs are rare complications of acute stroke with substantial burden. A significant proportion can be presented at the onset of stroke requiring an extensive diagnostic workup.

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Section: Not Reported -mentioning

confidence: 99%

“…Twenty studies reported clinical data with regard to ES type 19 , 20 , 22 – 24 , 27 , 30 , 32 , 35 , 36 , 38 – 40 , 46 – 48 , 50 , 51 , 53 , 54 . Based on their results, 63.8% (725/1137) seizures were partial and 35.2% (400/1137) were general at onset.…”

Section: Ess After Strokementioning

confidence: 99%

Early seizures after ischemic stroke: focus on thrombolysis

et al. 2019

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“…This may reflect the limited research on evidence-based acute stroke care interventions in Africa. It seems likely that informative research, yet unpublished, is underway currently, for example in Ghana [ 6 ], Congo [ 62 ], Morocco [ 44 ], Nigeria [ 71 ] and Egypt [ 72 ], indicating further emerging evidence of the availability of stroke unit care in hospital settings. Further, the quality of evidence from the included studies is low as the studies were non-experimental, non-randomised and did not adequately control for confounding covariates.…”

Section: Discussionmentioning

confidence: 99%

Interventions for acute stroke management in Africa: a systematic review of the evidence

et al. 2017

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BackgroundThe past decades have witnessed a rapid evolution of research on evidence-based acute stroke care interventions worldwide. Nonetheless, the evidence-to-practice gap in acute stroke care remains variable with slow and inconsistent uptake in low-middle income countries (LMICs). This review aims to identify and compare evidence-based acute stroke management interventions with alternative care on overall patient mortality and morbidity outcomes, functional independence, and length of hospital stay across Africa.MethodsThis review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. An electronic search was conducted in six databases comprising MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Academic Search Complete and Cochrane Library for experimental and non-experimental studies. Eligible studies were abstracted into evidence tables and their methodological quality appraised using the Joanna Briggs Institute checklist. Data were analysed and presented narratively with reference to observed differences in patient outcomes, reporting p values and confidence intervals for any possible relationship.ResultsInitially, 1896 articles were identified and 37 fully screened. Four non-experimental studies (three cohort and one case series studies) were included in the final review. One study focused on the clinical efficacy of a stroke unit whilst the remaining three reported on thrombolytic therapy. The results demonstrated a reduction in patient deaths attributed to stroke unit care and thrombolytic therapy. Thrombolytic therapy was also associated with reductions in symptomatic intracerebral haemorrhage (SICH). However, the limited eligible studies and methodological limitations compromised definitive conclusions on the extent of and level of efficacy of evidence-based acute stroke care interventions across Africa.ConclusionEvidence from this review confirms the widespread assertion of low applicability and uptake of evidence-based acute stroke care in LMICs. Despite the limited eligible studies, the overall positive patient outcomes following such interventions demonstrate the applicability and value of evidence-based acute stroke care interventions in Africa. Health policy attention is thus required to ensure widespread applicability of such interventions for improved patients’ outcomes. The review findings also emphasises the need for further research to unravel the reasons for low uptake.Systematic review registrationPROSPERO CRD42016051566 Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0594-4) contains supplementary material, which is available to authorized users.

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“…Stroke will remain a problem unless urgent action is taken in health promotion and the provision of facilities for optimal care within the resources available. Stroke units can provide crucial support for meeting some of these challenges and are available in some tertiary care facilities 49 .…”

Section: Older Adults To Oldest Oldmentioning

confidence: 99%

Nervous system disorders across the life course in resource-limited settings

Birbeck

Meyer

Ogunniyi

2015

Nature

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The resiliency of the adult nervous system is markedly affected by the environment and the circumstances during infant and child development. As such, adults in resource-limited settings who may have experienced early deprivation are particularly vulnerable to subsequent neurological disorders. Adult populations in countries with relatively recent advances in economic development may still have a higher susceptibility to neurological illness or injury that is reflective of the socioeconomic environment that was present during that population’s infancy and childhood. Brain and peripheral nervous system research conducted over the past decade in resource-limited settings has led to an impressive and growing body of knowledge that informs our understanding of neurological function and dysfunction, independent of geography. Neurological conditions feature prominently in the burgeoning epidemic of non-communicable diseases facing low- and middle-income countries. Neurological research in these countries is needed to address this burden of disease. Although the burden of more prevalent and severe neurological disease poses public health and clinical challenges in settings with limited neurological expertise, the same factors, along with genetic heterogeneity and the relative absence of ingrained clinical care practices, offer circumstances well-suited for the conduct of crucial future research that is globally relevant.

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Early post-acute stroke seizures: Clinical profile and outcome in a Nigerian stroke unit

Abstract: Profile of EPASS may appear different in terms of stroke subtype in Sub-Saharan African populations. Larger prospective studies may clarify the position better.

Cited by 15 publications

References 14 publications

Early seizures after ischemic stroke: focus on thrombolysis

Early seizures after ischemic stroke: focus on thrombolysis

Interventions for acute stroke management in Africa: a systematic review of the evidence

Nervous system disorders across the life course in resource-limited settings

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