Risk Factors for Postischemic Stroke Epilepsy in Young Adults: A Nationwide Population-Based Study in Taiwan

Thao, Phuong; Chen, Liying; Chan, Lung; Hu, Chaur‐Jong; Chien, Li‐Nien

doi:10.3389/fneur.2022.880661

Cited by 9 publications

(20 citation statements)

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“…It occurred twice that two articles reported on the same cohort (Hordaland County cohort Norway 21,22 and Sahlgrenska Academy Study on Ischemic Stroke Sweden), 23,24 but provided different information; thus, we included both. More than half of the studies (16/29) included a population of ischemic stroke only [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] (Table 1). Time since stroke while evaluating cognitive outcomes ranged from a few hours to 11 years, but almost half of the studies (13/29) reported on people in the chronic phase [21][22][23][24]26,28,30,31,36,[38][39][40][41] and the other half (14/29) included people in the non-chronic phase.…”

Section: Included Articlesmentioning

confidence: 99%

Cognitive impairment after a stroke in young adults: A systematic review and meta-analysis

Weterings

Kessels

Leeuw

et al. 2023

International Journal of Stroke

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Background Information about cognitive functioning is vital in the management of stroke, but the literature is mostly based on data from individuals older than 50 years of age who make up the majority of the stroke population. As cognitive functioning is subject to change due to ageing, it is unclear whether such cognitive impairment patterns from the general stroke literature apply to the growing population of younger people with a stroke. Aims To conduct a systematic review and meta-analysis of the proportion and severity of cognitive impairment in young-stroke patients. Summary of review MEDLINE, Embase, PsycINFO, and Web of Science were systematically searched up to 11 October 2022. Studies were included if they reported on a population of young-stroke patients, evaluated cognitive functioning as an outcome measure, and reported original data. We estimated the pooled prevalence rates for cognitive impairment and for aphasia. Additionally, we calculated the pooled estimates for the severity of impairment per cognitive domain in the chronic phase (defined as >6 months post-stroke). 635 articles were identified of which 29 were eligible for inclusion. The pooled prevalence of cognitive impairment was 44% (k=10; 95% CI: 34–54%) and of aphasia 22% (k=13; 95% CI: 12–39%). Young-stroke patients in the chronic phase performed worse than stroke-free healthy age-appropriate controls across all cognitive domains examined, with Hedge’s g effect sizes from −0.49 to −1.64. Conclusions Around half of all young-stroke patients present with cognitive impairment and around a quarter with aphasia. Our data suggests that patterns of impairment in young-stroke patients follow those in the general stroke literature.

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Section: Included Articlesmentioning

confidence: 99%

Cognitive impairment after a stroke in young adults: A systematic review and meta-analysis

Weterings

Kessels

Leeuw

et al. 2023

International Journal of Stroke

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“…Five studies (7.0%) had a high risk of bias, 35 studies (49.3%) presented a moderate risk of bias, and 31 studies (43.7%) had a low risk of bias (eTable 4 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…Statistical analyses were appropriate in 44 studies (62%) . Confounding factors were identified in 58 studies (81.7%) and were adjusted in the statistical analysis in 53 studies (74.6%) . Only 37 studies (52.1%) provided complete follow-up data.…”

Section: Resultsmentioning

confidence: 99%

“…Confounding factors were identified in 58 studies (81.7%) and were adjusted in the statistical analysis in 53 studies (74.6%) . Only 37 studies (52.1%) provided complete follow-up data. The outcomes were measured validly and reliably in 53 studies (74.6%) …”

Section: Resultsmentioning

confidence: 99%

“…Only 37 studies (52.1%) provided complete follow-up data. The outcomes were measured validly and reliably in 53 studies (74.6%) …”

Section: Resultsmentioning

confidence: 99%

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Outcomes in Patients With Poststroke Seizures

Misra,

Kasner,

Dawson

et al. 2023

JAMA Neurol

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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.

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