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BMC Neurology

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Open Access 01-12-2016 | Research article

Clinical predictors of seizure recurrence after the first post-ischemic stroke seizure

Authors: Hyeon Jin Kim, Kee Duk Park, Kyoung-Gyu Choi, Hyang Woon Lee

Published in: BMC Neurology | Issue 1/2016

Abstract

Background

The number of patients suffering post-stroke seizure after ischemic stroke (PSSi) is quite considerable, especially because ischemic stroke is more prevalent than hemorrhage in the general population. This study aimed to determine the predicting factors for seizure recurrence in ischemic stroke survivors and develop a clinical scoring system for the prediction of risks for seizure recurrence after the first PSSi.

Methods

We reviewed 3792 ischemic stroke patients from the Ewha Stroke Registry. A total of 124 (3.3 %) patients who experienced PSSi were recruited (mean follow-up for 44.4 months). Medical records concerning the etiology, functional disability, seizure onset latency from stroke, type of seizure, electroencephalography (EEG), and neuroimaging findings were statistically analyzed to derive a seizure recurrence risk scoring system.

Results

Seizures recurred in 35.4 % (17/48) of early PSSi patients (≤1 week since stroke onset) and 48.7 % (37/76) of late PSSi (>1 week) patients. Atrial fibrillation, large sized, and cortical stroke lesion were more common in late onset PSSi compared to those in early onset PSSi (p < 0.05). Seizure recurrence tended to be more prevalent in early PSSi patients with male gender, atrial fibrillation or cortical stroke lesion, severe functional disability, and partial seizures. Seizure recurrence in late PSSi group was more common in patients of young age (≤65 years old), male gender, large lesion size, and partial seizure type. The validity of seizure recurrence risk score in the early PSSi group was better when evaluating based on gender, atrial fibrillation, cortical lesion, functional disability, and partial seizure type, with sensitivity of 70.6 % and specificity of 71.0 %.

Conclusions

Our study characterized the high risk group for seizure recurrence in patients with the first PSSi. PSSi patients with high risk score of seizure recurrence had a greater chance of developing epilepsy later. Therefore, they should be considered for further treatment such as antiepileptic drug medication in clinical practice.

Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia. 1993;34(3):453–68.CrossRefPubMed

Merkler AE, Dunn LE, Lerario MP, Morris NA, Gialdini G, Kummer BR, Lahiri S, Navi BB, Kamel H. The Long-Term Risk of Seizures After Stroke. Stroke. 2016;47 Suppl 1:A109.

Conrad J, Pawlowski M, Dogan M, Kovac S, Ritter MA, Evers S. Seizures after cerebrovascular events: risk factors and clinical features. Seizure. 2013;22(4):275–82.CrossRefPubMed

Graham NS, Crichton S, Koutroumanidis M, Wolfe CD, Rudd AG. Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register. Stroke. 2013;44(3):605–11.CrossRefPubMed

Beghi E, D'Alessandro R, Beretta S, Consoli D, Crespi V, Delaj L, Gandolfo C, Greco G, La Neve A, Manfredi M, et al. Incidence and predictors of acute symptomatic seizures after stroke. Neurology. 2011;77(20):1785–93.CrossRefPubMed

Benbir G, Ince B, Bozluolcay M. The epidemiology of post-stroke epilepsy according to stroke subtypes. Acta Neurol Scand. 2006;114(1):8–12.CrossRefPubMed

Lossius MI, Ronning OM, Slapo GD, Mowinckel P, Gjerstad L. Poststroke epilepsy: occurrence and predictors--a long-term prospective controlled study (Akershus Stroke Study). Epilepsia. 2005;46(8):1246–51.CrossRefPubMed

Camilo O, Goldstein LB. Seizures and epilepsy after ischemic stroke. Stroke. 2004;35(7):1769–75.CrossRefPubMed

Lamy C, Domigo V, Semah F, Arquizan C, Trystram D, Coste J, Mas JL, Patent Foramen O, Atrial Septal Aneurysm Study G. Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology. 2003;60(3):400–4.CrossRefPubMed

10.

Cheung CM, Tsoi TH, Au-Yeung M, Tang AS. Epileptic seizure after stroke in Chinese patients. J Neurol. 2003;250(7):839–43.CrossRefPubMed

11.

Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Cote R, Lebrun L, Pirisi A, Norris JW. Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000;57(11):1617–22.CrossRefPubMed

12.

Arboix A, Garcia-Eroles L, Massons JB, Oliveres M, Comes E. Predictive factors of early seizures after acute cerebrovascular disease. Stroke. 1997;28(8):1590–4.CrossRefPubMed

13.

So EL, Annegers JF, Hauser WA, O'Brien PC, Whisnant JP. Population-based study of seizure disorders after cerebral infarction. Neurology. 1996;46(2):350–5.CrossRefPubMed

14.

Hesdorffer DC, Benn EK, Cascino GD, Hauser WA. Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure. Epilepsia. 2009;50(5):1102–8.CrossRefPubMed

15.

Sykes L, Wood E, Kwan J. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. Cochrane Database Syst Rev. 2014;1:CD005398.

16.

Gilad R. Management of seizures following a stroke: what are the options? Drugs Aging. 2012;29(7):533–8.CrossRefPubMed

17.

Neshige S, Kuriyama M, Yoshimoto T, Takeshima S, Himeno T, Takamatsu K, Sato M, Ota S. Seizures after intracerebral hemorrhage; risk factor, recurrence, efficacy of antiepileptic drug. J Neurol Sci. 2015;359(1–2):318–22.CrossRefPubMed

18.

Morgenstern LB, Hemphill 3rd JC, Anderson C, Becker K, Broderick JP, Connolly Jr ES, Greenberg SM, Huang JN, MacDonald RL, Messe SR, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41(9):2108–29.CrossRefPubMedPubMedCentral

19.

Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, Heo JH, Kwon SU, Oh CW, Lee BC, et al. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the korean stroke society and clinical research center for stroke. J Stroke. 2013;15(1):2–20.CrossRefPubMedPubMedCentral

20.

Beleza P. Acute symptomatic seizures: a clinically oriented review. Neurologist. 2012;18(3):109–19.CrossRefPubMed

21.

Marson A, Jacoby A, Johnson A, Kim L, Gamble C, Chadwick D. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet. 2005;365(9476):2007–13.CrossRefPubMed

22.

Gilad R, Lampl Y, Eschel Y, Sadeh M. Antiepileptic treatment in patients with early postischemic stroke seizures: a retrospective study. Cerebrovasc Dis. 2001;12(1):39–43.CrossRefPubMed

23.

Karhunen H, Jolkkonen J, Sivenius J, Pitkanen A. Epileptogenesis after experimental focal cerebral ischemia. Neurochem Res. 2005;30(12):1529–42.CrossRefPubMed

24.

Back T, Ginsberg MD, Dietrich WD, Watson BD. Induction of spreading depression in the ischemic hemisphere following experimental middle cerebral artery occlusion: effect on infarct morphology. J Cereb Blood Flow Metab. 1996;16(2):202–13.CrossRefPubMed

25.

Huang CW, Saposnik G, Fang J, Steven DA, Burneo JG. Influence of seizures on stroke outcomes: a large multicenter study. Neurology. 2014;82(9):768–76.CrossRefPubMed

26.

Burneo JG, Fang J, Saposnik G. Investigators of the Registry of the Canadian Stroke N: Impact of seizures on morbidity and mortality after stroke: a Canadian multi-centre cohort study. Eur J Neurol. 2010;17(1):52–8.CrossRefPubMed

27.

Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde BW, Engel J, French J, Glauser TA, Mathern GW, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia. 2010;51(4):676–85.CrossRefPubMed

28.

Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel Jr J, Forsgren L, French JA, Glynn M, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82.CrossRefPubMed

29.

Nair PP, Kalita J, Misra UK. Status epilepticus: why, what, and how. J Postgrad Med. 2011;57(3):242–52.CrossRefPubMed

30.

Beghi E, Carpio A, Forsgren L, Hesdorffer DC, Malmgren K, Sander JW, Tomson T, Hauser WA. Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010;51(4):671–5.CrossRefPubMed

31.

Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41.CrossRefPubMed

32.

Strzelczyk A, Haag A, Raupach H, Herrendorf G, Hamer HM, Rosenow F. Prospective evaluation of a post-stroke epilepsy risk scale. J Neurol. 2010;257(8):1322–6.CrossRefPubMed

33.

Kim LG, Johnson TL, Marson AG, Chadwick DW. Prediction of risk of seizure recurrence after a single seizure and early epilepsy: further results from the MESS trial. Lancet Neurol. 2006;5(4):317–22.CrossRefPubMed

34.

Velioglu SK, Ozmenoglu M, Boz C, Alioglu Z. Status epilepticus after stroke. Stroke. 2001;32(5):1169–72.CrossRefPubMed

35.

Fisher RS, van Emde BW, Blume W, Elger C, Genton P, Lee P, Engel Jr J. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4):470–2.CrossRefPubMed

36.

Kim JH, Lee HW, Cohen LG, Park KD, Choi KG. Motor cortical excitability in patients with poststroke epilepsy. Epilepsia. 2008;49(1):117–24.CrossRefPubMed

37.

Petrides G, Braga RJ, Fink M, Mueller M, Knapp R, Husain M, Rummans T, Bailine S, Malur C, O'Connor K, et al. Seizure threshold in a large sample: implications for stimulus dosing strategies in bilateral electroconvulsive therapy: a report from CORE. J ECT. 2009;25(4):232–7.CrossRefPubMedPubMedCentral

38.

Stein DG. Progesterone exerts neuroprotective effects after brain injury. Brain Res Rev. 2008;57(2):386–97.CrossRefPubMed

39.

Kraus JA, Berlit P. Cerebral embolism and epileptic seizures--the role of the embolic source. Acta Neurol Scand. 1998;97(3):154–9.CrossRefPubMed

40.

Willmore LJ, Ueda Y. Posttraumatic epilepsy: hemorrhage, free radicals and the molecular regulation of glutamate. Neurochem Res. 2009;34(4):688–97.CrossRefPubMed

41.

Carrera E, Michel P, Despland PA, Maeder-Ingvar M, Ruffieux C, Debatisse D, Ghika J, Devuyst G, Bogousslavsky J. Continuous assessment of electrical epileptic activity in acute stroke. Neurology. 2006;67(1):99–104.CrossRefPubMed

Title: Clinical predictors of seizure recurrence after the first post-ischemic stroke seizure
Authors: Hyeon Jin Kim
Kee Duk Park
Kyoung-Gyu Choi
Hyang Woon Lee
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Neurology / Issue 1/2016
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-016-0729-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Clinical predictors of seizure recurrence after the first post-ischemic stroke seizure

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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