Acute symptomatic seizures in patients with recurrent ischemic stroke: A multicentric study

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Epileptic Disorders Pub Date : 2024-09-05 DOI:10.1002/epd2.20279

Miguel Leal Rato, Miguel Schön, Maria Paula Zafra, Diana Aguiar de Sousa, Teresa Pinho e Melo, Ana Catarina Franco, Ana Rita Peralta, Carolina Ferreira-Atuesta, Luis Carlos Mayor-Romero, Rob P. W. Rouhl, Carla Bentes

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引用次数: 0

Abstract

Objective

Epileptic seizures occur frequently after stroke due to changes in brain function and structure, and up to around 10% of stroke patients experience stroke recurrence in the first year. We aimed to establish the risk of acute symptomatic seizures in patients with recurrent stroke.

Methods

Retrospective cohort study including consecutive admissions to a Stroke Unit due to acute ischemic stroke, during a 5-year period. Additional inclusion of patients admitted to two centers in different countries to corroborate findings (confirmatory cohort). We aimed to compare acute symptomatic seizure incidence in patients with and without previous stroke. Patients with history of epilepsy were excluded. Logistic regression modeling was performed to identify predictors in middle cerebral artery (MCA) stroke.

Results

We included 1473 patients (1085 with MCA stroke), of which 117 had a recurrent ischemic stroke (84 with MCA stroke). Patients with recurrent stroke had a seizure risk during hospital stay similar to that of patients with a first-ever stroke (5.1% vs. 4.5%, OR 1.15, 95% CI .48–2.71, p = .75). Risk of acute symptomatic seizures was also similar (5.0% vs. 4.1, OR 1.22, 95% CI .29–5.27, p = .78). Older age, female sex, and hemorrhagic transformation were predictors of seizures in patients with a first MCA ischemic stroke, but not in recurrent stroke patients. Electrographic characteristics were similar between the two groups in patients who had an electroencephalogram (46 with first stroke, 5 with recurrent stroke). The low rate of seizures (1.5%) in the confirmatory cohort (n = 198) precluded full comparison with the initial cohort. Nevertheless, the rate of seizures was not higher in stroke recurrence.

Significance

History of previous stroke was not associated with an increased risk of acute symptomatic seizures during hospital stay. Larger, prospective studies, with prospective electrophysiological evaluation, are needed to explore the impact of stroke recurrence on seizure risk.

查看原文本刊更多论文

复发性缺血性脑卒中患者的急性症状性癫痫发作：一项多中心研究。

目的：由于脑功能和结构的改变，中风后经常会出现癫痫发作，多达约 10%的中风患者会在第一年内中风复发。我们旨在确定复发性中风患者急性症状性癫痫发作的风险：方法：回顾性队列研究，包括 5 年内因急性缺血性中风连续入住中风病房的患者。另外还纳入了不同国家两个中心收治的患者，以证实研究结果（确证队列）。我们的目的是比较曾患中风和未患中风患者的急性症状性癫痫发作率。有癫痫病史的患者被排除在外。采用逻辑回归模型确定大脑中动脉（MCA）卒中的预测因素：我们纳入了 1473 例患者（1085 例为 MCA 中风），其中 117 例为复发性缺血性中风（84 例为 MCA 中风）。复发性中风患者在住院期间的癫痫发作风险与首次中风患者相似（5.1% vs. 4.5%，OR 1.15，95% CI .48-2.71，p = .75）。急性症状发作的风险也相似（5.0% vs. 4.1，OR 1.22，95% CI .29-5.27，p = .78）。高龄、女性和出血性转变是首次 MCA 缺血性卒中患者癫痫发作的预测因素，但不是复发性卒中患者癫痫发作的预测因素。两组患者的脑电图特征相似（46 例首次中风患者，5 例复发中风患者）。由于确诊组群（n = 198）的癫痫发作率较低（1.5%），因此无法与初始组群进行全面比较。尽管如此，中风复发患者的癫痫发作率并不高：意义：既往中风史与住院期间急性症状性癫痫发作风险增加无关。需要进行更大规模的前瞻性研究，并进行前瞻性电生理评估，以探讨中风复发对癫痫发作风险的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epileptic Disorders 医学-临床神经学

CiteScore

4.10

自引率

8.70%

发文量

138

审稿时长

6-12 weeks

期刊介绍： Epileptic Disorders is the leading forum where all experts and medical studentswho wish to improve their understanding of epilepsy and related disorders can share practical experiences surrounding diagnosis and care, natural history, and management of seizures. Epileptic Disorders is the official E-journal of the International League Against Epilepsy for educational communication. As the journal celebrates its 20th anniversary, it will now be available only as an online version. Its mission is to create educational links between epileptologists and other health professionals in clinical practice and scientists or physicians in research-based institutions. This change is accompanied by an increase in the number of issues per year, from 4 to 6, to ensure regular diffusion of recently published material (high quality Review and Seminar in Epileptology papers; Original Research articles or Case reports of educational value; MultiMedia Teaching Material), to serve the global medical community that cares for those affected by epilepsy.