Risk factors for post-stroke seizures: A systematic review and meta-analysis

Zhang, Chao; Wang, Xiu; Wang, Yao; Zhang, Jianguo; Hu, Wenhan; Ge, Ming; Zhang, Kai; Shao, Xiaoqiu

doi:10.1016/j.eplepsyres.2014.09.030

Cited by 128 publications

(128 citation statements)

References 44 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…Epileptic seizures are a common complication after stroke although the risk to develop seizures varies, depending on variables such as stroke type (hemorrhagic vs. ischemic), stroke severity, and cortical involvement [1–7]. Seizures occurring after stoke are divided in early-onset seizures (ES, incidence 3.3% of patients) and late-onset seizures (LS, incidence 18 in 1000 person years) depending on their time of occurrence, with a variable cut-off point in different studies between 24 h and 1 month post-stroke [2, 6, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study

et al. 2018

View full text Add to dashboard Cite

ObjectiveEpileptic seizures are a common complication after stroke. The relation between occurrence of seizures after stroke and long-term mortality remains elusive. We aimed to assess whether seizures in an early or late phase after ischemic stroke are an independent determinant of long-term mortality.MethodsWe prospectively included and followed 444 ischemic stroke patients with a first-ever supratentorial brain infarct for at least 2 years after their stroke regarding the occurrence of seizures. The final follow-up for mortality is from April 2015 (follow-up duration 24.5–27.8 years, mean 26.0 years, SD 0.9 years). We compared patients with early-onset seizures with all seizure-free patients, whereas the patients with late-onset seizures were compared with the 1-week survivors without any seizures. We used Cox-regression analyses to correct for possible confounding factors.ResultsKaplan–Meier analysis showed significantly higher mortality for the patients with early-onset seizures (p = 0.002) but after correction for known risk factors for (long term) mortality early-onset seizures had no independent influence on long-term mortality (HR 1.09; 95% CI 0.64–1.85). In patients with late-onset seizures, no significant influence from late-onset seizures on long-term mortality was found (univariate p = 0.717; multivariate HR 0.81; 95% CI 0.54–1.20).ConclusionBoth early-onset and late-onset seizures do not influence long-term mortality after ischemic stroke.

show abstract

Section: Introductionmentioning

confidence: 99%

The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…3-20 However, the data regarding the incidence of post-stroke seizures, risk factors for their development, and their effect on mortality and functional outcome of stroke survivors vary substantially across studies. 21-25 Differing study designs, definitions of early and late seizures and epilepsy, varying lengths and completeness of follow-up all contribute for this variability. Additionally, there are no recent randomized controlled trials that would answer the question whether antiepileptic drugs (AEDs) have any benefit for primary and secondary prevention of post-ischemic stroke seizures.…”

Section: Introductionmentioning

confidence: 99%

Seizures Following Ischemic Stroke: Frequency of Occurrence and Impact on Outcome in a Long-Term Population-Based Study

Bryndziar

Šedová

Kramer

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

View full text Add to dashboard Cite

Background & Purpose Seizures are a known complication of ischemic stroke. This study assesses the long-term incidence and characteristics of post-stroke seizures in a well-defined population. Methods Utilizing the Rochester Epidemiology Project medical record linkage system, we identified all incident cases of ischemic stroke (IS) among Rochester, MN residents from 1990-1994, and followed the patients in the comprehensive medical record through March 2014. All patients with post-stroke seizures were identified, and data regarding incident IS, seizures, and status at last follow-up were analyzed. Results We identified 489 patients with first IS. Mean follow-up was 6.5 (SD 6.3) years. New onset seizures occurred in 35 patients (7.2%). Patients with post-stroke seizure did not differ from those without in terms of IS etiologic subtype (p=0.44) or IS risk factors (p>0.05). Early seizures (within 14 days of index stroke) developed in 14 patients (40%), the majority within the first 24 hours (n=9; 64.3%). The median time of seizure onset for the remaining 21 patients was 13.8 months. Functional outcome, as measured by modified Rankin scale, was worse following development of post-stroke seizures (mean mRS 2.9 after IS, 3.3 following index seizure; p=0.005), and mortality was higher as well, even after adjusting for IS etiologic subtype (HR 1.52; 95% CI 1.07-2.16; p=0.02). Conclusion Development of post-stroke seizures is an infrequent, but significant complication of ischemic stroke, portending a worse short-term functional outcome and a higher long-term mortality rate. Seizure occurrence did not differ based on IS etiologic subtype or stroke risk factors.

show abstract

“…18,19 In our study, studies exclusively enrolling haemorrhagic stroke patients showed a higher frequency of interictal epileptiform activity but not of electrographic seizures. Furthermore, the frequency of events was not different in studies solely focused on SAH.…”

Section: Discussionmentioning

confidence: 80%

Frequency of post-stroke electroencephalographic epileptiform activity – a systematic review and meta-analysis of observational studies

Bentes

Rodrigues

Sousa

et al. 2017

European Stroke Journal

View full text Add to dashboard Cite

Introduction: Cerebrovascular diseases are the most frequent risk factor for epilepsy in the elderly, and epileptic phenomenon following stroke is known to worsen the prognosis. Although electroencephalography is the gold standard epilepsy biomarker, it is rarely used in post-stroke studies, and the frequency of post-stroke epileptiform activity is still uncertain. Patients and methods: We analysed studies indexed to MEDLINE, Embase, Web of Science, PsycINFO and OpenGrey (up to March 2015), reporting post-stroke electroencephalographic epileptiform activity frequency in adults. Epileptiform activity was classified as ictal (electrographic seizures) and interictal (non-periodic spikes and sharp waves). Data selection, extraction and appraisal were done in duplicate. Random-effects meta-analysis was used to pool frequencies. Results: The pooled frequency of post-stroke ictal and interictal epileptiform activity was 7% (95% CI 3%-12%) and 8% (95% CI 4%-13%), respectively. The use of continuous electroencephalogram was not associated with an increased frequency of electrographic seizures (p ¼ 0.05), nor did the management setting (Intensive Care Unit versus nonIntensive Care Unit, p ¼ 0.31). However, studies with continuous electroencephalogram showed a higher frequency of interictal epileptiform activity (p ¼ 0.01). Discussion: This study provides the best available estimates of the frequency of post-stroke electroencephalographic epileptiform activity. Due to detection bias, it was not possible to correlate clinical and electrographic seizures. Conclusion: The frequency of ictal and interictal epileptiform activity in the electroencephalogram was comparable with previous frequency analyses of clinical seizures. The frequency of ictal epileptiform activity did not change with continuous record or clinical setting, while the frequency of interictal epileptiform activity increased with continuous record.

show abstract

Risk factors for post-stroke seizures: A systematic review and meta-analysis

Cited by 128 publications

References 44 publications

The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study

The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study

Seizures Following Ischemic Stroke: Frequency of Occurrence and Impact on Outcome in a Long-Term Population-Based Study

Frequency of post-stroke electroencephalographic epileptiform activity – a systematic review and meta-analysis of observational studies

Contact Info

Product

Resources

About