Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2018

Open Access 01-12-2018 | Research article

Association between different acute stroke therapies and development of post stroke seizures

Authors: Jillian Naylor, Arthur Thevathasan, Leonid Churilov, Ruibing Guo, Yunyun Xiong, Miriam Koome, Ziyi Chen, Ziyuan Chen, Xinfeng Liu, Patrick Kwan, Bruce C. V. Campbell

Published in: BMC Neurology | Issue 1/2018

Login to get access

Abstract

Background

Epilepsy is a major complication of stroke. We aimed to establish whether there is an association between intravenous thrombolysis, intra-arterial thrombolysis and post stroke seizure (PSS) development. Improved understanding of the relationship between reperfusion therapies and seizure development may improve post-stroke monitoring and follow-up.

Methods

This was a retrospective, multicentre cohort study conducted at the Royal Melbourne Hospital and Jingling Hospital Nanjing. We included patients with anterior circulation ischemic stroke admitted 2008–2015. Patients were divided into four treatment groups 1. IV-tPA only, 2. Intra-arterial therapies (IAT) only, 3. IAT + IV-tPA and 4. stroke unit care only (i.e. no IV-tPA or IAT). To assess the association between type of reperfusion treatment and seizure incidence we used multivariable logistic regression models adjusted for age, stroke severity, 3-month functional outcome and prognostic factors.

Results

There were 1375 stroke unit care-only patients, of whom 28 (2%) developed PSS. There were 363 patients who received only IV-tPA, of whom 21 (5.8%) developed PSS. There were 93 patients who received IAT only, of whom 12 (12.9%) developed PSS and 112 that received both IV-tPA + IAT, of which 5 (4.5%) developed PSS. All reperfusion treatments were associated with seizure development compared to stroke unit care-only patients: IV-tPA only adjusted odds ratio (aOR) 3.7, 95%CI 1.8–7.4, p < 0.0001; IAT aOR 5.5, 95%CI 2.1–14.3, p < 0.0001, IAT + IV-tPA aOR 3.4, 95% CI 0.98–11.8, p = 0.05. These aORs did not differ significantly between treatment groups (IV-tPA + IAT versus IV-tPA p = 0.89, IV-tPA + IAT versus IAT, p = 0.44).

Conclusions

Patients receiving thrombolytic or intra-arterial reperfusion therapies for acute ischemic stroke are at higher risk of epilepsy and may benefit from longer follow-up. No evidence for an additive or synergistic effect of treatment modality on seizure development was found.
Appendix
Available only for authorised users
Literature
1.
Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol. 2013;12(6):585–96.PubMedCrossRef
2.
Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95.PubMedCrossRef
3.
Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Roman L, Serena J, Abilleira S, Ribo M, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.PubMedCrossRef
4.
Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20.PubMedCrossRef
5.
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.PubMedCrossRef
6.
Campbell BC, Mitchell PJ, Investigators E-I. Endovascular therapy for ischemic stroke. N Engl J Med. 2015;372(24):2365–6.PubMed
7.
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, et al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet. 2014;383(9913):245–54.PubMedPubMedCentralCrossRef
8.
9.
10.
Pitkanen A, Loscher W, Vezzani A, Becker AJ, Simonato M, Lukasiuk K, Grohn O, Bankstahl JP, Friedman A, Aronica E, et al. Advances in the development of biomarkers for epilepsy. Lancet Neurol. 2016;15(8):843–56.PubMedCrossRef
11.
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.PubMedCrossRef
12.
De Reuck J, Van Maele G. Acute ischemic stroke treatment and the occurrence of seizures. Clin Neurol Neurosurg. 2010;112(4):328–31.PubMedCrossRef
13.
Alvarez V, Rossetti AO, Papavasileiou V, Michel P. Acute seizures in acute ischemic stroke: does thrombolysis have a role to play? J Neurol. 2013;260(1):55–61.PubMedCrossRef
14.
Tan ML, Ng A, Pandher PS, Sashindranath M, Hamilton JA, Davis SM, O'Brien TJ, Medcalf RL, Yan B, Jones NC. Tissue plasminogen activator does not alter development of acquired epilepsy. Epilepsia. 2012;53(11):1998–2004.PubMedCrossRef
15.
Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Hoxter G, Mahagne MH, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European cooperative acute stroke study (ECASS). JAMA. 1995;274(13):1017–25.PubMedCrossRef
16.
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.PubMedCrossRef
17.
Koome M, Churilov L, Chen Z, Chen Z, Naylor J, Thevathasan A, Yan B, Kwan P. Computed tomography perfusion as a diagnostic tool for seizures after ischemic stroke. Neuroradiology. 2016;58(6):577–84.PubMedCrossRef
18.
Chen A, Akinyemi RO, Hase Y, Firbank MJ, Ndung'u MN, Foster V, Craggs LJ, Washida K, Okamoto Y, Thomas AJ, et al. Frontal white matter hyperintensities, clasmatodendrosis and gliovascular abnormalities in ageing and post-stroke dementia. Brain. 2016;139(Pt 1):242–58.PubMedCrossRef
19.
Chen Z, Churilov L, Koome M, Chen Z, Naylor J, Kwan P, Yan B. Post-stroke seizures is associated with low Alberta stroke program early CT score. Cerebrovasc Dis. 2017;43(5–6):259–65.PubMedCrossRef
20.
Keezer MR, Pelletier A, Stechysin B, Veilleux M, Jette N, Wolfson C. The diagnostic test accuracy of a screening questionnaire and algorithm in the identification of adults with epilepsy. Epilepsia. 2014;55(11):1763–71.PubMedCrossRef
21.
Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J Jr, Forsgren L, French JA, Glynn M, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82.PubMedCrossRef
22.
Zhang C, Wang X, Wang Y, Zhang JG, Hu W, Ge M, Zhang K, Shao X. Risk factors for post-stroke seizures: a systematic review and meta-analysis. Epilepsy Res. 2014;108(10):1806–16.PubMedCrossRef
23.
24.
Tanaka T, Yamagami H, Ihara M, Motoyama R, Fukuma K, Miyagi T, Nishimura K, Toyoda K, Nagatsuka K. Seizure outcomes and predictors of recurrent post-stroke seizure: a retrospective observational cohort study. PLoS One. 2015;10(8):e0136200.PubMedPubMedCentralCrossRef
25.
Berges S, Moulin T, Berger E, Tatu L, Sablot D, Challier B, Rumbach L. Seizures and epilepsy following strokes: recurrence factors. Eur Neurol. 2000;43(1):3–8.PubMedCrossRef
26.
Krakow K, Sitzer M, Rosenow F, Steinmetz H, Foerch C, Arbeitsgruppe Schlaganfall H. Predictors of acute poststroke seizures. Cerebrovasc Dis. 2010;30(6):584–9.PubMedCrossRef
27.
Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, Johnston KC, Johnston SC, Khalessi AA, Kidwell CS, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020–35.PubMedCrossRef
28.
Inoue M, Noda R, Yamaguchi S, Tamai Y, Miyahara M, Yanagisawa S, Okamoto K, Hara T, Takeuchi S, Miki K, et al. Specific factors to predict large-vessel occlusion in acute stroke patients. J Stroke Cerebrovasc Dis. 2017;4:886–91.
29.
van Mook WN, Rennenberg RJ, Schurink GW, van Oostenbrugge RJ, Mess WH, Hofman PA, de Leeuw PW. Cerebral hyperperfusion syndrome. Lancet Neurol. 2005;4(12):877–88.PubMedCrossRef
30.
Hafeez F, Razzaq MA, Levine RL, Ramirez MA. Reperfusion seizures: a manifestation of cerebral reperfusion injury after administration of recombinant tissue plasminogen activator for acute ischemic stroke. J Stroke Cerebrovasc Dis. 2007;16(6):273–7.PubMedCrossRef
31.
Jean WC, Spellman SR, Nussbaum ES, Low WC. Reperfusion injury after focal cerebral ischemia: the role of inflammation and the therapeutic horizon. Neurosurgery. 1998;43(6):1382–96. discussion 1396-1387PubMed
32.
33.
Wang YF, Tsirka SE, Strickland S, Stieg PE, Soriano SG, Lipton SA. Tissue plasminogen activator (tPA) increases neuronal damage after focal cerebral ischemia in wild-type and tPA-deficient mice. Nat Med. 1998;4(2):228–31.PubMedCrossRef
34.
Sussman ES, Connolly ES Jr. Hemorrhagic transformation: a review of the rate of hemorrhage in the major clinical trials of acute ischemic stroke. Front Neurol. 2013;4:69.PubMedPubMedCentralCrossRef
Metadata
Title
Association between different acute stroke therapies and development of post stroke seizures
Authors
Jillian Naylor
Arthur Thevathasan
Leonid Churilov
Ruibing Guo
Yunyun Xiong
Miriam Koome
Ziyi Chen
Ziyuan Chen
Xinfeng Liu
Patrick Kwan
Bruce C. V. Campbell
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2018
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-018-1064-x

Other articles of this Issue 1/2018

BMC Neurology 1/2018 Go to the issue

Research article

Low self-reported sports activity before stroke predicts poor one-year-functional outcome after first-ever ischemic stroke in a population-based stroke register

Case report

Unusual presentation of a skull base mass lesion in sarcoidosis mimicking malignant neoplasm: a case report

Research article

Trends in stroke outcomes in the last ten years in a European tertiary hospital

Case report

Case series of Creutzfeldt-Jakob disease in a third-level hospital in Quito

Research article

Cardiac autonomic neuropathy in type 1 and type 2 diabetes patients

Case report

Pleocytosis in a patient with relapsing polychondritis accompanied by meningoencephalitis: a case report