Incidence, predictors, and outcomes of post-thrombectomy seizures in the extended time window

Abstract

Mechanical thrombectomy 6–24 h after the last time where a patient was known to be without signs or symptoms of a stroke is the standard of care for patients with a stroke due to large vessel occlusion. This is referred to as thrombectomy within an extended time window. There have been very few studies looking at patients who had seizures within the first week (early post-stroke seizures) following mechanical thrombectomy in this extended time window. Our study suggests that this group of patients does not have a higher incidence of early post stroke seizures. Our findings do reveal however, that patients who do have early post-stroke seizures may have a less favorable functional outcome at 90 days than those who did not develop early seizures. Hence, rapid identification and subsequent treatment of seizures in these patients is important.

Incidence and association of seizures in stroke patients following endovascular treatment: A systematic review and meta‐analysis

“…Based on the inclusion and exclusion criteria, 16 eligible articles were ultimately identified; a flow chart of the selection process is shown in Figure 1. Amongst the included articles, 11 [9–11, 13, 23–29] were cohort studies, four [30–33] had cross‐sectional designs and one [12] was a case–control study. These studies were conducted in France (one [30]), Spain (one [23]), the USA (two [31, 33]), Germany (three [11, 12, 32]), Sweden (one [24]), Italy (one [13]), China (one [25]), Switzerland (one [29]), Australia (three [9, 27, 28]); and one study that was conducted simultaneously in China and Australia [26]; another study was a matched multicentre study [10].…”

“…Amongst the included articles, 11 [9–11, 13, 23–29] were cohort studies, four [30–33] had cross‐sectional designs and one [12] was a case–control study. These studies were conducted in France (one [30]), Spain (one [23]), the USA (two [31, 33]), Germany (three [11, 12, 32]), Sweden (one [24]), Italy (one [13]), China (one [25]), Switzerland (one [29]), Australia (three [9, 27, 28]); and one study that was conducted simultaneously in China and Australia [26]; another study was a matched multicentre study [10]. The overall number of ischaemic stroke patients included in our analyses was 12,664; the mean age of the participants was 70 years, and males predominated slightly at 56%.…”

“…Previously, ASSs were referred to as ‘early seizures’ and unprovoked seizures as ‘late seizures’, but following the recent ILAE redefinition of PSS these terms have been abandoned [1]. Furthermore, the time windows for the occurrence of ASS and PSE were different in the literature; for example, 11 [10–13, 23, 24, 28, 30–33] articles used 7 days, one [29] study used 24 h, two [9, 26] articles defined PSE as the onset of seizures within 2 years after stroke, one [27] study argued that a single unprovoked seizure (occurring in 8–30 days) was not equivalent to PSE, and one [25] study did not clarify the definition. These inconsistencies may lead to misleading results.…”

Effect of Reperfusion Therapies on Incidence of Early Post-Stroke Seizures

“…Many studies suggest a less favorable functional outcome in patients receiving either reperfusion treatments if the course is complicated by early PSS (17,25,(31)(32)(33)(34)(35)(36). It is indeed relieving to know that there is no indirect decline in the benefit from these treatments through an undesirable increase in seizures.…”