Seizures in Ischemic Stroke

Kim, Benny S.; Sila, Cathy A.

doi:10.1007/978-1-4939-2559-9_2

Cited by 5 publications

(14 citation statements)

References 49 publications

(90 reference statements)

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“…Untreated, these electrical patterns were associated with focal cortical or subcortical dysfunction that could progress to epilepsy. 7,8 Bilateral independent periodic discharges represented a wider area of cortical damage and were associated with acute and subacute disease. 5,7 These EEG findings were recorded in cases of meningitis, encephalitis, and multiorgan failure.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Bilateral independent periodic discharges represented a wider area of cortical damage and were associated with acute and subacute disease. 5,7 These EEG findings were recorded in cases of meningitis, encephalitis, and multiorgan failure. Generalized periodic discharges were the consequence of extensive cortical and subcortical damage which occurred in severe encephalopathy or following a status epilepticus.…”

Section: Discussionmentioning

confidence: 99%

“…Acute ischemic strokes caused lateralized periodic discharges during the dynamic phase of the ischemic insult. 7,8,10,11 Lateralized periodic discharges were the result of an external zone of hyperexcitability that led to synchronous and repetitive rhythms by the disruption of subcortical networks. [7][8][9][10] Subcortical lesions damaged the underlying basal ganglia and the associated thalamocortical networks, resulting in reciprocal propagation of oscillations to widespread areas of the cerebral cortex.…”

Section: Periodic Discharges In Strokesmentioning

confidence: 99%

“…7,8,10,11 Lateralized periodic discharges were the result of an external zone of hyperexcitability that led to synchronous and repetitive rhythms by the disruption of subcortical networks. [7][8][9][10] Subcortical lesions damaged the underlying basal ganglia and the associated thalamocortical networks, resulting in reciprocal propagation of oscillations to widespread areas of the cerebral cortex. 7,10 Acute ischemia resulted in neuronal injury and release of excitotoxic neurotransmitters such as glutamate, which triggered recurrent epileptiform discharges.…”

Section: Periodic Discharges In Strokesmentioning

confidence: 99%

“…[7][8][9][10] Subcortical lesions damaged the underlying basal ganglia and the associated thalamocortical networks, resulting in reciprocal propagation of oscillations to widespread areas of the cerebral cortex. 7,10 Acute ischemia resulted in neuronal injury and release of excitotoxic neurotransmitters such as glutamate, which triggered recurrent epileptiform discharges. [7][8][9][10] Early onset seizures in cortical strokes increased the size of the infarct and the residual functional deficits.…”

Section: Periodic Discharges In Strokesmentioning

confidence: 99%

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Concepts in Periodic Discharges: A Descriptive Study

Khanna

Agarwal

Kandel

2018

International Journal of Epilepsy

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Introduction Periodic discharges are now known as the ictal–interictal continuum and represent ongoing injury in acute or chronic neurological illnesses. Objective The aim of our study was to identify periodic discharges in patients who have undergone continuous bedside electroencephalography (EEG) monitoring and to classify the EEG according to the current American Clinical Neurophysiology Society terminology. Materials and Methods The continuous bedside EEG records of intensive care patients admitted from August 2017 to July 2018 were analyzed. The clinical spectrum, the treatment, and outcome of each of these patients were monitored. Results Fifty cases of periodic discharges (11 children, 39 adults) were identified over 1 year from 2017 to 2018. The clinical presentation included 32% seizures, 16% status epilepticus, 20% coma, 16% fever with altered sensorium, 8% abnormal behavior, 4% strokes, and 4% traumatic brain injury. The diagnosis was 20% autoimmune encephalitis, 8% herpes encephalitis, 20% multiorgan failure, 4% traumatic brain injury, 16% status epilepticus, 16% posthypoxic encephalopathy, 4% strokes, 4% intracerebral bleeds, 4% meningitis, and 4% severe dementia. Lateralized periodic discharges were identified in 20%, bilateral independent periodic discharges in 20%, and generalized periodic discharges in 60%. Fifty-six percent patients recovered with residual neurological deficits and 44% succumbed to their illness. Conclusions Continuous bedside EEG monitoring has revolutionized the approach to seizures in critically ill patients. Despite a vigilant approach and diligent diagnosis of these abnormal rhythms, the mortality rate was 20% in patients with lateralized periodic discharges and 60% with bilateral and generalized periodic discharges (p ≤ 0.05).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Periodic Discharges In Strokesmentioning

confidence: 99%

Section: Periodic Discharges In Strokesmentioning

confidence: 99%

Section: Periodic Discharges In Strokesmentioning

confidence: 99%

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Concepts in Periodic Discharges: A Descriptive Study

Khanna

Agarwal

Kandel

2018

International Journal of Epilepsy

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Early seizures after ischemic stroke: focus on thrombolysis

et al. 2019

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Introduction.Stroke is a significant underlying cause of epilepsy. Seizures due to ischemic stroke (IS) are generally categorized into early seizures (ESs) and late seizures (LSs). Seizures in thrombolysis situations may raise the possibility of other etiology than IS.Aim.We overtook a systematic review focusing on the pathogenesis, prevalence, risk factors, detection, management, and clinical outcome of ESs in IS and in stroke/thrombolysis situations. We also collected articles focusing on the association of recombinant tissue-type plasminogen activator (rt-PA) treatment and epileptic seizures.Results.We have identified 37 studies with 36,775 participants. ES rate was 3.8% overall in patients with IS with geographical differences. Cortical involvement, severe stroke, hemorrhagic transformation, age (<65 years), large lesion, and atrial fibrillation were the most important risk factors. Sixty-one percent of ESs were partial and 39% were general. Status epilepticus (SE) occurred in 16.3%. 73.6% had an onset within 24 h and 40% may present at the onset of stroke syndrome. Based on EEG findings seizure-like activity could be detected only in approximately 18% of ES patients. MRI diffusion-weighted imaging and multimodal brain imaging may help in the differentiation of ischemia vs. seizure. There are no specific recommendations with regard to the treatment of ES.Conclusion.ESs are rare complications of acute stroke with substantial burden. A significant proportion can be presented at the onset of stroke requiring an extensive diagnostic workup.

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Effects of atorvastatin and aspirin on post-stroke epilepsy and usage of levetiracetam

Zhao¹,

Ding

Feng³

et al. 2020

Medicine

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Objective: Atorvastatin and aspirin have been used in treating different forms of epilepsy. However, their effect on post-stroke epilepsy (PSE) still needs to be validated by large-scale clinical studies. In addition, their impact on the use of the antiepileptic drug levetiracetam for post-stroke epilepsy remains to be explored. Thus, the aim of this study was to further evaluate the effect of atorvastatin and aspirin on PSE and their effect on the usage of the antiepileptic drug levetiracetam in PSE patients. Methods: Patients, aged 65 to 85 years, with newly diagnosed post-ischemic stroke epilepsy from August 30, 2014 to August 30, 2018 were included in the study, with the exclusion of those with coexisting conditions. Results: Initially, 1321 patients were included, and 780 remained in the study at the 1-year follow-up. During the study, atorvastatin treatment with or without aspirin reduced the number of clinical epileptic episodes in PSE patients. It also reduced the dosage of levetiracetam and achieved better control of epilepsy compared to levetiracetam mono-treatment. Aspirin co-treatment with levetiracetam did not result in a significant improvement. However, the combination of aspirin with atorvastatin significantly reduced the number of seizures compared to atorvastatin treatment alone. Conclusion: Atorvastatin and aspirin co-treatment with levetiracetam can reduce epilepsy in PSE patients and reduce the dosage of levetiracetam required for effective control of PSE.

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Seizures in Ischemic Stroke

Cited by 5 publications

References 49 publications

Concepts in Periodic Discharges: A Descriptive Study

Concepts in Periodic Discharges: A Descriptive Study

Early seizures after ischemic stroke: focus on thrombolysis

Effects of atorvastatin and aspirin on post-stroke epilepsy and usage of levetiracetam

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