Outcomes in Patients With Poststroke Seizures

Abstract

ImportancePublished data about the impact of poststroke seizures (PSSs) on the outcomes of patients with stroke are inconsistent and have not been systematically evaluated, to the authors’ knowledge.ObjectiveTo investigate outcomes in people with PSS compared with people without PSS.Data SourcesMEDLINE, Embase, PsycInfo, Cochrane, LILACS, LIPECS, and Web of Science, with years searched from 1951 to January 30, 2023.Study SelectionObservational studies that reported PSS outcomes.Data Extraction and SynthesisThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for abstracting data, and the Joanna Briggs Institute tool was used for risk-of-bias assessment. Data were reported as odds ratio (OR) and standardized mean difference (SMD) with a 95% CI using a random-effects meta-analysis. Publication bias was assessed using funnel plots and the Egger test. Outlier and meta-regression analyses were performed to explore the source of heterogeneity. Data were analyzed from November 2022 to January 2023.Main Outcomes and MeasuresMeasured outcomes were mortality, poor functional outcome (modified Rankin scale [mRS] score 3-6), disability (mean mRS score), recurrent stroke, and dementia at patient follow-up.ResultsThe search yielded 71 eligible articles, including 20 110 patients with PSS and 1 166 085 patients without PSS. Of the participants with PSS, 1967 (9.8%) had early seizures, and 10 605 (52.7%) had late seizures. The risk of bias was high in 5 studies (7.0%), moderate in 35 (49.3%), and low in 31 (43.7%). PSSs were associated with mortality risk (OR, 2.1; 95% CI, 1.8-2.4), poor functional outcome (OR, 2.2; 95% CI, 1.8-2.8), greater disability (SMD, 0.6; 95% CI, 0.4-0.7), and increased dementia risk (OR, 3.1; 95% CI, 1.3-7.7) compared with patients without PSS. In subgroup analyses, early seizures but not late seizures were associated with mortality (OR, 2.4; 95% CI, 1.9-2.9 vs OR, 1.2; 95% CI, 0.8-2.0) and both ischemic and hemorrhagic stroke subtypes were associated with mortality (OR, 2.2; 95% CI, 1.8-2.7 vs OR, 1.4; 95% CI, 1.0-1.8). In addition, early and late seizures (OR, 2.4; 95% CI, 1.6-3.4 vs OR, 2.7; 95% CI, 1.8-4.1) and stroke subtypes were associated with poor outcomes (OR, 2.6; 95% CI, 1.9-3.7 vs OR, 1.9; 95% CI, 1.0-3.6).Conclusions and RelevanceResults of this systematic review and meta-analysis suggest that PSSs were associated with significantly increased mortality and severe disability in patients with history of stroke. Unraveling these associations is a high clinical and research priority. Trials of interventions to prevent seizures may be warranted.

Pathophysiology, Diagnosis, Prognosis, and Prevention of Poststroke Epilepsy

“… 58 A comprehensive meta-analysis of 37,420 patients with poststroke seizures and 1,840,906 patients without poststroke seizures (N = 72 journal articles) found that patients with poststroke seizures are at significantly high dementia risk (OR 3.1; 95% CI 1.3–7.7) and odds for mortality (OR 2.1; 95% CI 1.8–2.5) and poor outcomes (OR 2.4; 95% CI 1.9–3.1). 3 Although the exact mechanism is unknown, repetitive clinical seizures may cause permanent damage to the brain, or using ASMs may impair cognitive function. Furthermore, cognition can also be affected by multiple factors such as the stroke lesion itself, adverse effects of ASMs, drug interactions, social restrictions that affect mood, and changes in environmental factors owing to seizures.…”

“… 2 PSE is a critical determinant of stroke prognosis and is associated with a high risk of mortality, poor outcomes, and more extended hospital stay. 3 In addition, PSE, in conjunction with poststroke dementia, contributes to the complexity of stroke recovery, causing unplanned and costly hospital admissions, life-threatening emergencies, and social life restrictions. 3 Advances in acute stroke care are expected to increase the number of survivors in the European Union by 27% from 2017 to 2047.…”

“… 3 In addition, PSE, in conjunction with poststroke dementia, contributes to the complexity of stroke recovery, causing unplanned and costly hospital admissions, life-threatening emergencies, and social life restrictions. 3 Advances in acute stroke care are expected to increase the number of survivors in the European Union by 27% from 2017 to 2047. 4 We, therefore, need a collaborative effort toward drug discovery to prevent PSE.…”

Polygenic Risk of Epilepsy and Post-Stroke Epilepsy

“…Post-stroke epilepsy (PSE) is a debilitating complication of stroke associated with poor cognition, functional outcomes, and increased mortality. 1 Its incidence ranges from 2-20% and increases to 50% in the elderly population over 60 years. 2 The epilepsy risk is 23 times greater after a stroke than in the general population.…”