Prevalence and predictors of early seizure and status epilepticus after first stroke

Labovitz, Daniel L.; Hauser, W. Allen; Sacco, Ralph L.

doi:10.1212/wnl.57.2.200

Cited by 253 publications

(252 citation statements)

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“…25) NCSE was reported in 3-8% of patients with aneurysmal subarachnoid hemorrhage, 23,24) but no cases of NCSE were identified in 904 patients with CVD. 22) These contradictory results are probably due to heterogeneous definitions and diagnostic criteria of NCSE. Some reports originate from tertiary epilepsy centers or neuro-intensive care units (neuro-ICU), which have continuous EEG monitoring facilities, 14) whereas others are population-based.…”

Section: Discussionmentioning

confidence: 99%

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Nonconvulsive Status Epilepticus During Perioperative Period of Cerebrovascular Surgery

Morioka

Sayama

Mukae

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Nonconvulsive status epilepticus (NCSE) is generally defined as a change in behavior and/or mental process from the baseline, which is associated with ongoing seizure activity or continuous epileptiform discharges on electroencephalography (EEG) in the absence of convulsive seizures. The present study investigated NCSE incidence using serial EEG during the perioperative periods of cerebrovascular surgery at a medium-sized, local hospital. A total of 54 patients were admitted to our department and underwent various neurosurgical procedures over a course of one year. If clinical symptoms worsened without clear explanation, EEG was performed, resulting in a diagnosis of NCSE in four patients (7.4%). The EEG abnormalities included periodic lateralized epileptiform discharges in 1 patient, triphasic waves in 2 patients, and repeated ictal discharges in 1 patient. Improved mental status and consciousness level, together with disappearance of EEG abnormalities, after appropriate anticonvulsant treatment supported the diagnosis of NCSE. The present study stressed the importance of EEG if no adequate explanation for neurological deterioration can be determined from the clinical course, laboratory data, or neuroimaging examination.

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Section: Discussionmentioning

confidence: 99%

“…9,25,30) The incidence of convulsive status epilepticus in the population with cerebrovascular disease (CVD) remains unclear, but is estimated at 14-30%. 8,22,28,32) In contrast, the incidence of NCSE in patients with CVD is relatively unstudied. 18,23) The diagnosis of NCSE requires clinical suspicion and EEG confirmation.…”

Section: Introductionmentioning

confidence: 99%

Nonconvulsive Status Epilepticus During Perioperative Period of Cerebrovascular Surgery

Morioka

Sayama

Mukae

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…These differences likely reflect the fact that patients with ICH have a higher risk to develop seizures and SE as compared with those with IS (Labovitz et al, 2001). Patients with ICH have a higher early case fatality than do those with ISs.…”

Section: The Influence Of Differences Between Patient Groupsmentioning

confidence: 99%

“…Bilateral disease, conversely, is a marker for severe arteriosclerosis and/or cardiac disease (Roh et al, 2000;Kang et al, 2003) with a high risk of cardiovascular death (Kaarisalo et al, 1997;Wong and Li, 2003;Stollberger et al, 2004). Conversely, bilateral cerebrovascular disease represents more extensive disease that is associated with an increased risk to develop seizures or SE (Arboix et al, 1997;Labovitz et al, 2001). Therefore one hypothesis contributing to the increased case fatality in the SE group observed is that SE in patients with cerebrovascular lesions reflects extensive cerebrovascular disease and indicates an increased risk of cardiovascular death, which remains high in the long term.…”

Section: Factors Contributing To the Increased Case Fatality After Sementioning

confidence: 99%

Status Epilepticus after Stroke Is Associated with Increased Long‐term Case Fatality

Knake¹,

Rochon

Fleischer³

et al. 2006

Epilepsia

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Summary:Purpose: The aim of this study was to determine the long-term case fatality of patients with a first episode of status epilepticus (SE group) of cerebrovascular etiology, as compared with that in acute stroke patients without SE (AS group).Methods: Patients with SE who had been prospectively admitted to an epidemiologic study were retrospectively compared with a cohort of patients from the local stroke registry. The main outcome end point was overall survival. Survival curves were generated according to the Kaplan-Meier method and compared by using the log-rank test. An extended Cox model was used to examine the impact of patient group on the risk of death. Covariates considered potential confounders included age at diagnosis, sex, type of stroke, affected hemisphere, and localization of lesions.Results: Of 166 patients who entered the study, 93 patients were in the SE group, and 73 patients were in the AS group; 53 SE patients and 35 AS patients died during the study. Patient group (SE vs. AS) showed no significant impact on survival (p = 0.0832) in univariate analysis. In contrast, the results from a multivariable analysis suggest that after 6 months, patients with SE were at about twice the risk of death as were patients with AS [hazard ratio of 2.12 with 95% confidence interval, 1.04-4.32, p = 0.0392].Conclusions: The occurrence of SE in patients with cerebrovascular disease indicates a high risk of death within 3 years. In contrast, the case fatality risk attributable to recurrent status or seizures is lower. Key Words: Long-term mortality-Case fatality-Risk factors-Causes of death-Status epilepticus.Status epilepticus (SE) is a major neurologic emergency with an incidence of ∼20/100,000 for the white population in industrialized countries. Several studies have described determinants of mortality among patients with SE (Lowenstein and Alldredge, 1998). Most of these studies have investigated mortality after SE up to a maximum follow-up period of <1 year, mostly up to 30 days or to discharge from hospital (Aminoff and Simon, 1980;Barry and Hauser, 1993;Scholtes et al., 1994;Towne et al., 1994;Logroscino et al., 1997).SE was associated with short-term mortality rates of ∼20% (Hauser, 1990;DeLorenzo et al., 1995;Logroscino et al., 1997;Lowenstein and Alldredge, 1998;Knake et al., 2001;Rosenow et al., 2002;Wu et al., 2002). Patient age at diagnosis, etiology of SE (especially anoxia), severity of the underlying disease. and duration of SE were main predictors of increased short-term mortality (Hauser, 1990;Lowenstein and Alldredge, 1998;Wu et al., 2002 In contrast, available reports examining long-term mortality after SE are sparse. Only one recent study systematically analyzed mortality at more than 10 years after the first episode of SE and found an increased long-term mortality of 43%, significantly associated with older age, status duration >24 h, acute symptomatic etiology including stroke, and myoclonic SE caused by hypoxic brain injury (Logroscino et al., 2002).The authors concluded that SE alone...

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“…In the literature, stroke severity was found to be a predictor of clinical poststroke seizures in some studies, [21][22][23][24] but not all. 25 Recent elec- trophysiologic studies using cEEG in patients admitted to an intensive care unit 7,8 did not find stroke severity to be a predictor of electrical epileptic seizures. In our study, the independent effect of stroke severity may be due to patient selection.…”

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confidence: 99%

Pergolide-induced ergotism

Morgan

Sethi²

2006

Neurology

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Abstract-Objective: To determine the incidence and risk factors of electrical seizures and other electrical epileptic activity using continuous EEG (cEEG) in patients with acute stroke. Methods: One hundred consecutive patients with acute stroke admitted to our stroke unit underwent cEEG using 10 electrodes. In addition to electrical seizures, repetitive focal sharp waves (RSHWs), repetitive focal spikes (RSPs), and periodic lateralized epileptic discharges (PLEDs) were recorded. Results: In the 100 patients, cEEG was recorded for a mean duration of 17 hours 34 minutes (range 1 hour 12 minutes to 37 hours 10 minutes). Epileptic activity occurred in 17 patients and consisted of RSHWs in seven, RSPs in seven, and PLEDs in three. Electrical seizures occurred in two patients. On univariate Cox regression analysis, predictors for electrical epileptic activity were stroke severity (high score on the National Institutes of Health Stroke Scale) (hazard ratio [HR] 1.12; p ϭ 0.002), cortical involvement (HR 5.71; p ϭ 0.021), and thrombolysis (HR 3.27; p ϭ 0.040). Age, sex, stroke type, use of EEG-modifying medication, and cardiovascular risk factors were not predictors of electrical epileptic activity. On multivariate analysis, stroke severity was the only independent predictor (HR 1.09; p ϭ 0.016). Conclusion: In patients with acute stroke, electrical epileptic activity occurs more frequently than previously suspected. NEUROLOGY 2006;67:99-104 Patients with acute stroke treated in a stroke unit show a relative reduction in mortality.1 Recent guidelines 2-4 have put forward recommendations for the organization of stroke units and defined the usefulness of several acute diagnostic tests, including brain CT and MRI, laboratory examinations, duplex and transcranial ultrasonography, and monitoring of blood pressure, EKG, oxygen saturation, and body temperature. These guidelines also provide strategies for the treatment of acute stroke, including general care and specific therapies, such as recanalization or prevention of complications.However, the role of continuous EEG (cEEG) monitoring in the stroke unit has not been adequately assessed, despite the high incidence of clinical seizures, which ranges from 2 to 33% in the acute phase of stroke, 5 and the potentially harmful effect of seizures on acute ischemic tissue. 6 The information regarding the usefulness of cEEG in acute stroke was obtained in studies on severe stroke patients admitted to intensive care units. Electrical seizures were detected in 9 to 15% of patients, depending on patient selection and the cEEG technique. [7][8][9] In this study, we sought to determine the incidence and risk factors of electrical seizure and epileptic electrical activity in acute stroke patients admitted to our stroke unit.Methods. Subject selection. We prospectively recruited 100 consecutive patients admitted to our stroke unit. Inclusion criteria were acute symptoms and signs consistent with ischemic or hemorrhagic stroke. Exclusion criteria were subarachnoid or posttraumatic hemorr...

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Prevalence and predictors of early seizure and status epilepticus after first stroke

Abstract: Lesion location and stroke subtype are strong determinants of ES risk, even after adjusting for stroke severity. ES does not predict 30-day mortality. SE occurs in more than one-quarter of patients with ES.

Cited by 253 publications

References 23 publications

Nonconvulsive Status Epilepticus During Perioperative Period of Cerebrovascular Surgery

Nonconvulsive Status Epilepticus During Perioperative Period of Cerebrovascular Surgery

Status Epilepticus after Stroke Is Associated with Increased Long‐term Case Fatality

Pergolide-induced ergotism

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