Risk factors for early–onset seizures after stroke: A systematicreview and meta‐analysis of 18 observational studies

Ma, Sitian; Fan, Xiaoxuan; Zhao, Xiaoping; Wang, Kai; Wang, Huan; Yang, Yongfeng

doi:10.1002/brb3.2142

Cited by 10 publications

(11 citation statements)

References 37 publications

(119 reference statements)

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“…This study found that there was no statistically significant difference between the three groups as regard history of diabetes mellitus, hypertension, heart diseases, atrial fibrillation, carotid stenosis and collagen diseases. In agreement with a study found that the above factors have no obvious relationship with the occurrence of early seizures [8]. In contrast to a study showed that there is a high correlation between hypertension, diabetes mellitus, heart diseases and the occurrence of early seizures [9].…”

Section: Discussionsupporting

confidence: 89%

Stroke-related early seizures: clinical and neurophysiological study in a sample of Egyptian population

Mohamed

Rakawy

Abdelhamid

et al. 2023

Egypt J Neurol Psychiatry Neurosurg

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Background Available data collected from patients of different types of acute cerebrovascular strokes can detect risk factors, clinical data (including semiology of seizures), EEG findings and functional outcome of these patients. Stroke, both ischemic and hemorrhagic, has been considered an essential cause of epilepsy, especially in the elderly. Complications of acute stroke during the early days after the insult determine the ultimate outcome of events. The aim of this study is to determine the clinical and neurophysiological characteristics of stroke patients with or without clinical evident fits for early detection and better management. Results The brain imaging of the cases group who developed seizures showed that 50% of the cases have arterial ischemic infarction, 30% venous infarction, 6.67% ischemic infarction with haemorrhagic transformation, 6.67% intracerebral haemorrhage and 6.67% have subarachnoid haemorrhage. Based on the 2017 ILAE criteria, 43.33% of the patients developed focal to bilateral tonic clonic seizures, 33.33% developed focal aware seizures, 16.67% of the patients developed generalized tonic clonic seizures and 6.67% of the patient developed status epilepticus. EEG findings of the group of patients who developed seizures showed, focal slowing in 46.67%, focal epileptiform activity in 13.33%, focal activity with secondary generalization in 10%, PLEDS in 6.67%, generalized epileptiform activity in 6.67%, generalized slowing in 6.67% and normal EEG in 10% of the patients. Non convulsive status was found in 2 patients (6.67%) of the group with altered mental status. There was no PLEDS in EEG of group of patients without clinical seizures. This study did not find age and sex differences in patients with and without seizures. In addition, it was found that there was no statistically significant difference between the three groups as regard history of diabetes mellitus, hypertension, heart diseases, atrial fibrillation, carotid stenosis and collagen diseases. There was no significant relationship between seizures and early treatment with Rtpa and thrombectomy. Conclusions Focal to bilateral tonic clonic and focal aware seizures were the most prevalent type of early onset seizures after stroke, followed by generalized tonic clonic seizures and status epilepticus. Most EEG findings in this study were focal slowing, focal epileptiform activities, generalized epileptiform activities and PLEDS.

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Section: Discussionsupporting

confidence: 89%

Stroke-related early seizures: clinical and neurophysiological study in a sample of Egyptian population

Mohamed

Rakawy

Abdelhamid

et al. 2023

Egypt J Neurol Psychiatry Neurosurg

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“…Our study indicated that HT and sICH are risk factors for earlyonset seizures. A meta-analysis showed that the incidence of earlyonset seizures in the intracerebral haemorrhage group was greater than that in the cerebral infarction group [41], which provides support for our conclusion. The pathogenesis might be explained by the epileptogenic effect of blood degradation products on cortical neurons.…”

Section: Discussionsupporting

confidence: 81%

Prognostic significance of the clinical and radiological haemorrhagic transformation subtypes in acute ischaemic stroke: A systematic review and meta‐analysis

Zhang

et al. 2022

Euro J of Neurology

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Background and purpose:The aim was to investigate the associations of haemorrhagic transformation (HT) and its clinical and radiological subtypes with functional outcome, mortality, early neurological deterioration (END) and neurological complications in patients with acute ischaemic stroke (AIS). Methods: A systematic review and meta-analysis of observational studies on the associations of overall HT, clinical HT subtypes (asymptomatic intracerebral haemorrhage [aICH] and symptomatic intracerebral haemorrhage [sICH]) or radiological HT subtypes (haemorrhagic infarction [HI-1 or HI-2] and parenchymal haemorrhage [PH-1 or PH-2]) with prognosis in patients with AIS was performed. PubMed, Web of Science and Embase were systematically searched. Random effects models were used to calculate pooled estimates.Results: Fifty-one studies with 100,510 patients were pooled in the meta-analysis.Overall HT was associated with worse functional outcome (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.55-2.90), increased mortality (OR 1.87, 95% CI 1.52-2.30), END (OR 2.35, 95% CI 1.46-3.77), early-onset seizures (OR 2.58, 95% CI 1.63-4.10) and poststroke epilepsy (OR 2.23, 95% CI 1.11-4.49). For clinical subtypes, sICH remained significantly associated with the aforementioned poor prognoses except post-stroke epilepsy, and aICH was associated with worse functional outcome but was unrelated to mortality.For radiological subtypes, PH (especially PH-2) was strongly associated with poor prognosis. HI-2 was associated with worse functional outcome, and HI-1 was associated with a lower risk of mortality and END.Conclusions: Regardless of whether AIS patients undergo thrombolysis or thrombectomy, overall HT, sICH and PH (especially PH-2) are associated with a substantially increased risk of worse functional outcome, mortality, END or neurological complications. The presence of aICH is related to worse functional outcome but is independent of increased mortality. HI-2 impairs functional independence, and HI-1 does not cause neurological impairment.

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“…It was found that patients with severe strokes, cortical involvement and large‐vessel occlusion are more likely to receive EVT. However, several studies have reported that the independent risk factors for PSS include the severity of stroke, large‐artery atherosclerotic aetiology, cortical involvement and middle cerebral artery involvement [5, 10, 40–42]; these factors were combined into a predictive model named SeLECT to predict the occurrence of PSE [6]. Therefore, patients who received EVT are more likely to be associated with subsequent seizures compared to those who did not.…”

Section: Discussionmentioning

confidence: 99%

“…Post-stroke seizures are associated with a worse functional outcome, a higher mortality rate and increased risk of comorbidities [4]. Many risk factors of PSSs (cortical involvement, haemorrhagic transformation, intracerebral haemorrhage [5] and baseline stroke severity [6]) have been identified; however, the role of endovascular treatment (EVT) for PSSs is controversial. Several articles have reported that the underlying mechanisms leading to PSS include reperfusion syndrome [7], subsequent inflammatory reaction [8] and haemorrhagic complication [9], whilst other studies did not confirm these findings [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Deng

et al. 2022

Euro J of Neurology

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Background and purpose: Post-stroke seizures (PSSs) are some of the most common complications of stroke and are associated with poor outcomes in patients. Endovascular treatment (EVT) is the standard of care for patients with acute ischaemic stroke related large-vessel occlusion. However, whether EVT increases the risk of PSSs remains controversial; the association between PSSs and EVT is poorly understood.Methods: PubMed, Embase and the Cochrane Library were searched for relevant studies published from 1995 to 6 December 2021. The overall incidence of PSSs in patients treated with EVT and the separate incidence for all included studies in each subgroup, stratified by the type of treatment or time of onset, were calculated. The pooled odds ratio and confidence interval were calculated to quantify the effects of EVT on PSS occurrence.Results: In all, 946 studies were screened and 16 articles were included, with a total sample size of 12,664 patients; 7836 patients received EVT, of whom 460 had PSS. The pooled incidence of PSS after EVT was 5.8%, which was similar to patients treated with mechanical thrombectomy (5.3%), intra-arterial thrombolysis (6.8%) or bridging therapy (5.4%). The cumulative incidence of post-stroke epilepsy (6.0%) was almost twice that of acute symptomatic seizures (3.6%). The pooled odds ratio for the relationship between EVT and PSS was 1.91 (95% confidence interval 0.98-3.73). Conclusions:The cumulative incidence of stroke patients treated with EVT who developed seizures was 5.8%, and EVT was non-significantly associated with the occurrence of seizures after stroke.

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Risk factors for early–onset seizures after stroke: A systematicreview and meta‐analysis of 18 observational studies

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 10 publications

References 37 publications

Stroke-related early seizures: clinical and neurophysiological study in a sample of Egyptian population

Stroke-related early seizures: clinical and neurophysiological study in a sample of Egyptian population

Prognostic significance of the clinical and radiological haemorrhagic transformation subtypes in acute ischaemic stroke: A systematic review and meta‐analysis

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

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