Epileptic Seizures following Subcortical  Infarcts

Bentes, Carla; Pimentel, José; Ferro, José M.

doi:10.1159/000047730

Cited by 45 publications

(27 citation statements)

References 16 publications

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“…Moreover, this study pointed that occipital localization of the DWI changes is also associated with LLW. The significance of the predominant location of the changes in the occipital cortical region remains unexplained, and contradicts with the previous reports which show these lesions primarily in the thalamus and the temporal lobe [22,26,28,29,30,31]. In general, a possible explanation for the pattern of hemispheric diffusion changes is the shift of water associated with protracted epileptical activity.…”

Section: Discussioncontrasting

confidence: 64%

Impact of Poststroke Seizures on Neurological Deficits: Magnetic Resonance Diffusion-Weighted Imaging Study

Kumral

Uncu²,

Dönmez³

et al. 2013

Eur Neurol

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Background: The impact of poststroke seizures on the neurological deficits related to ischemic stroke is not well known. It has been reported that following poststroke epilepsy, transient or long-lasting worsening of the poststroke sequelae may develop, but the underlying mechanism of deficit worsening has not been systematically studied by magnetic resonance diffusion-weighted imaging (MRI-DWI). Methods: From 2008 to 2009, 1,010 ischemic stroke patients were admitted to our stroke unit at the Ege University Hospital with first-time strokes. Of these, 76 (7.5%) patients developed delayed seizures in a follow-up period of 18 months. We extracted the clinical and imaging data of the patients from our Stroke Registry databases and other medical records, and evaluated brain MRI, including spin-echo DWI with apparent diffusion coefficient (ADC) maps, FLAIR and T2-weighted images. Results: There were 15 (20%) patients who had long-lasting worsening of the previous neurological sequelae, which we called long-lasting neurological worsening (LLW); 38 (50%) had transient neurological worsening (TNW) and 23 (30%) were without neurological worsening (WNW) after poststroke seizures. DWI findings were present in 3/23 (13%) patients with simple partial-type seizure, in 4/17 (29%) patients with complex partial-type seizure, and in 7/13 (54%) patients with generalized toni-clonic type seizure (p = 0.002). Patients with LLW showed more frequent changes on DWI than those with TNW (53 vs. 16%; p = 0.009). Forty percent of patients with LLW and 5% of those with TNW had ADC decrease (p = 0.004). Patients with LLW had DWI changes in the occipital region more frequently than those with TNW (57 vs. 18%; p = 0.05). Correlation analysis found a significant association between LLW and DWI changes, multiple DWI lesions, ADC decrease, and recurrent seizures. In the control MRI-DWI 1 month after the poststroke seizure, no signal abnormalities were detected in neuroimaging studies of all patients. Despite no functional outcome differences between the groups before the seizure, the functional scales 1 week after the seizure (National Institutes of Health Stroke Scale, Modified Rankin Scale and Barthel Index) showed significantly worse neurological functional statements in the patients with LLW than those with TNW and WNW (p = 0.001). Conclusions: Poststroke seizures may affect poststroke sequelae transiently, which we see more often, but some seizure types may prolong the duration of deficits. Multiple DWI changes and LLW following recurrent and longer poststroke seizures were strongly associated, and this may be due to the effect of seizures causing additional metabolical changes.

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Section: Discussioncontrasting

confidence: 64%

Impact of Poststroke Seizures on Neurological Deficits: Magnetic Resonance Diffusion-Weighted Imaging Study

Kumral

Uncu²,

Dönmez³

et al. 2013

Eur Neurol

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“…68 For example, 1 retrospective study reported seizures in 3.5% of patients with lacunar stroke. 69 In SASS, seizures were reported in 8 (2.6%) of 307 patients with a diagnosis of lacunar infarction. 30 However, CT scanning was normal in the majority of these patients, and brain MRI was not performed; therefore, the possibility of cortical involvement cannot be completely excluded.…”

Section: Stroke Locationmentioning

confidence: 99%

Seizures and Epilepsy After Ischemic Stroke

Camilo

Goldstein

2004

Stroke

351

252

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Background-Although a long-recognized clinical phenomenon, there remain many questions regarding the epidemiology of seizures and epilepsy after ischemic stroke, their effect on outcome, and their treatment. Summary of Review-Interpretation of the various studies that have been conducted of postischemic stroke seizures and epilepsy are complicated by their heterogeneous designs, inconsistent uses of terminology, small sample sizes, different periods of follow-up, and ambiguities in seizure identification and classification. Estimates of the rate of early postischemic stroke seizures range from 2% to 33%. The rates of late seizures vary from 3% to 67%. The rate of postischemic stroke epilepsy is Ϸ2% to 4% and is higher in those who have a late seizure. Data reflecting seizure subtypes are limited. Aside from cortical location and, possibly, stroke severity, no other risk factors for postischemic stroke seizures have been consistently demonstrated. Results regarding the impact of postischemic stroke seizures on outcome are inconsistent. Conclusions-Much additional work is needed to better understand the epidemiology and social impact of postischemic stroke seizures and epilepsy, their prevention, and optimal management.

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“…Epilepsy can also be a consequence of subcortical infarcts [5] . The frequency of epilepsy in large series of CADASIL patients is approximately 10%, mostly occurring as a late symptom [1,2,6,7] .…”

Section: Discussionmentioning

confidence: 99%