Stroke-Related Seizures and the Role of Cortical and Subcortical Structures

Daniele, Ornella; Cacciatore, Giuseppe; Ferraro, Giuseppe; Mattaliano, A.; Tassinari, C. A.; Natalè, E

doi:10.1016/0896-6974(96)00005-9

Cited by 11 publications

(9 citation statements)

References 35 publications

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“…Studies that have included children with AIS, intracerebral hemorrhage, and sinovenous thrombosis have reported seizures in 27–58% at presentation (16–19) or within the initial several weeks (20, 21). This is consistent with a large number of adult stroke studies that report early seizures (22), variably defined as within the first 24 hours or several weeks, as occurring in 2–33% (23–29), with the majority occurring within the first 24 hours (30–32). …”

Section: Discussionsupporting

confidence: 89%

Seizures as a Presenting Symptom of Acute Arterial Ischemic Stroke in Childhood

Abend

Beslow

Smith

et al. 2011

The Journal of Pediatrics

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Objectives To define incidence of seizures as a presenting symptom of acute arterial ischemic stroke (AIS) in children and to determine whether younger age, infarct location, or AIS etiology were risk factors for seizure at AIS presentation. Study design Children aged 2 months to 18 years presenting with AIS from January 2005 to December 2008 were identified from a single center prospective pediatric stroke registry. Clinical data were abstracted, and a neuroradiologist reviewed imaging studies. Results Among 60 children who met inclusion criteria, seizures occurred at stroke presentation in 13 (22%). Median age was significantly younger in children who presented with seizures than in those who did not (1.1 versus 10 years, p=0.0009). Seizures were accompanied by hemiparesis in all patients. Three of four children with clinically overt seizures at presentation also had non-convulsive seizures on continuous EEG monitoring. Conclusions About one-fifth of children with acute AIS present with seizures. Seizures were always accompanied by focal neurologic deficits. Younger age was a risk factor for seizures at presentation. Seizure at presentation was not associated with infarct location or etiology. Non-convulsive seizures may occur during the acute period.

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Section: Discussionsupporting

confidence: 89%

Seizures as a Presenting Symptom of Acute Arterial Ischemic Stroke in Childhood

Abend

Beslow

Smith

et al. 2011

The Journal of Pediatrics

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“…17,[31][32][33] For example, in the series of Daniele et al, stroke patients with subcortical lesions, mainly in the basal ganglia, had generalized tonic-clonic seizures. 17 In our VLSM study, only left-hemispheric, not right-hemispheric, stroke lesions were associated with PSE. Hemispheric differences in the occurrence of epilepsy and seizure duration have been shown in previous work.…”

Section: Discussionmentioning

confidence: 99%

“…Strokerelated neuronal ischemic reactions, edema formation, accumulation of cytotoxic agents, and altered neuronal transmitter activity have been discussed in previous studies. 16,17 A strength of the present study is that we assessed detailed associations between the occurrence of PSE and ischemic lesions by determining voxel-wise lesions, then assessing the voxel-specific lesion overlap in our entire sample of stroke patients, and finally performing analyses between voxel-wise lesion overlap and occurrence of PSE. 18,19 VLSM analyses are statistic imaging analyses for calculating associations between lesion location in the brain and a functional neurologic deficit.…”

Section: Discussionmentioning

confidence: 99%

Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy

Winder

Bobinger

Seifert

et al. 2023

Journal of Neuroimaging

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Background and Purpose:The relationship between ischemic stroke site and occurrence of poststroke epilepsy (PSE) is incompletely understood. This study intended to evaluate incidence and temporal profiles of seizures and to correlate ischemic lesion sites with PSE using voxel-based lesion symptom mapping (VLSM). Methods:Patients with imaging-confirmed first-ever ischemic stroke without prior history of epilepsy were prospectively included. Demographic data, cardiovascular risk factors, and National Institute of Health Stroke Scale (NIHSS) scores were assessed. Data on seizures and modified Rankin scale scores were determined within a 90-day period after stroke onset. Ischemic lesion sites were correlated voxel wise with occurrence of PSE using nonparametric permutation test. Age-and sex-matched patients with first-ever ischemic strokes without PSE after 90 days served as controls for the VLSM analysis. Results:The stroke database contained 809 patients (mean age: 68.4 ± 14.2 years) with first-ever imaging-confirmed ischemic strokes without history of epilep. Incidence of PSE after 90-day follow-up was 2.8%. Five additional patients were admitted to the emergency department with a seizure after 90-day follow-up. Fifty percent of the seizures occurred in the acute phase after stroke. PSE patients had higher NIHSS scores and infarct volumes compared to controls without PSE (p < .05). PSE patients had infarcts predominantly involving the cerebral cortex. The hemisphere-specific VLSM analysis shows associations between PSE and damaged voxels in the left-hemispheric temporo-occipital transition zone. Conclusions:The data indicate that PSE occurs in a small proportion of patients with rather large ischemic strokes predominantly involving the cerebral cortex. Especially patients with ischemic lesions in the temporo-occipital cortex are vulnerable to develop PSE.

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“…The incidence of post-intracerebral hemorrhage (ICH) seizures varies between 0% and 28% [25-28,29••]. Location of the hematoma is important, with the highest risk for seizures found with lobar or subcortical ICH and zero risk with posterior fossa hemorrhage [5,[25][26][27]30]. In a prospective study, immediate seizures occurred in 4.2% of ICH patients (most of them simple partial) and early seizures in 3.8% (most of them generalized) [27].…”

Section: Seizures After Intracerebral Hemorrhagementioning

confidence: 99%

Management of seizures in critically ill patients

Varelas

Mirski²

2004

Curr Neurol Neurosci Rep

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For many neurologists, seizures in critically ill patients represent a difficult problem. Etiology can be elusive because of the complexity of the environment, and treatment decisions can be compromised by the paucity of evidence-based guidelines. Emerging data support a higher than previously thought incidence of nonconvulsive epileptic activity in this patient population, which is another important consideration. Although a seizure in the intensive care unit should be treated aggressively, prophylactic antiepileptic drug administration is dependent on the specific etiology, time of onset, and ensuing complications. After ischemic stroke, prophylactic treatment is not generally recommended, and after intracerebral hemorrhage treatment is recommended only after a few weeks. After subarachnoid hemorrhage, prophylactic treatment beyond discharge is also not recommended. Although there is no reason to believe that late seizures after severe head trauma cannot be prevented with prophylactic treatment, such an approach may be useful during the first week after the injury. Physicians, however, have to individualize the treatment to the critical patient after stroke or trauma based on the presence of additional factors that increase the risk for seizures, including structural cortical injuries and medications used in critical illness with epileptogenic potential. A general therapeutic scheme for seizures in the intensive care unit and the role newer antiepileptic drugs can play are also presented in this review.

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Stroke-Related Seizures and the Role of Cortical and Subcortical Structures

Cited by 11 publications

References 35 publications

Seizures as a Presenting Symptom of Acute Arterial Ischemic Stroke in Childhood

Seizures as a Presenting Symptom of Acute Arterial Ischemic Stroke in Childhood

Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy

Management of seizures in critically ill patients

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