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Journal of Neurology

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Open Access 01-08-2018 | Original Communication

The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study

Authors: J. H. van Tuijl, E. P. M. van Raak, R. J. van Oostenbrugge, A. P. Aldenkamp, R. P. W. Rouhl

Published in: Journal of Neurology | Issue 8/2018

Abstract

Objective

Epileptic seizures are a common complication after stroke. The relation between occurrence of seizures after stroke and long-term mortality remains elusive. We aimed to assess whether seizures in an early or late phase after ischemic stroke are an independent determinant of long-term mortality.

Methods

We prospectively included and followed 444 ischemic stroke patients with a first-ever supratentorial brain infarct for at least 2 years after their stroke regarding the occurrence of seizures. The final follow-up for mortality is from April 2015 (follow-up duration 24.5–27.8 years, mean 26.0 years, SD 0.9 years). We compared patients with early-onset seizures with all seizure-free patients, whereas the patients with late-onset seizures were compared with the 1-week survivors without any seizures. We used Cox-regression analyses to correct for possible confounding factors.

Results

Kaplan–Meier analysis showed significantly higher mortality for the patients with early-onset seizures (p = 0.002) but after correction for known risk factors for (long term) mortality early-onset seizures had no independent influence on long-term mortality (HR 1.09; 95% CI 0.64–1.85). In patients with late-onset seizures, no significant influence from late-onset seizures on long-term mortality was found (univariate p = 0.717; multivariate HR 0.81; 95% CI 0.54–1.20).

Conclusion

Both early-onset and late-onset seizures do not influence long-term mortality after ischemic stroke.

Alberti A, Paciaroni M, Caso V, Venti M, Palmerini F, Agnelli G (2008) Early seizures in patients with acute stroke: frequency, predictive factors, and effect on clinical outcome. Vasc Health Risk Manag 4(3):715–720PubMedPubMedCentral

Bladin CF, Alexandrov AV, Bellavance A et al (2000) Seizures after stroke: a prospective multicenter study. Arch Neurol 57(11):1617–1622CrossRefPubMed

De Herdt V, Dumont F, Henon H et al (2011) Early seizures in intracerebral hemorrhage: incidence, associated factors, and outcome. Neurology 77(20):1794–1800CrossRefPubMed

Rossi C, De Herdt V, Dequatre-Ponchelle N, Henon H, Leys D, Cordonnier C (2013) Incidence and predictors of late seizures in intracerebral hemorrhages. Stroke 44(6):1723–1725CrossRefPubMed

Procaccianti G, Zaniboni A, Rondelli F, Crisci M, Sacquegna T (2012) Seizures in acute stroke: Incidence, risk factors and prognosis. Neuroepidemiology 39(1):45–50CrossRefPubMed

Lancman ME, Golimstok A, Norscini J, Granillo R (1993) Risk factors for developing seizures after a stroke. Epilepsia 34(1):141–143CrossRefPubMed

Zhang C, Wang X, Wang Y et al (2014) Risk factors for post-stroke seizures: a systematic review and meta-analysis. Epilepsy Res 108(10):1806–1816CrossRefPubMed

Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C (1997) Epileptic seizures after a first stroke: the Oxfordshire community stroke project. BMJ 315(7122):1582–1587CrossRefPubMedPubMedCentral

Wang JZ, Vyas MV, Saposnik G, Burneo JG (2017) Incidence and management of seizures after ischemic stroke: systematic review and meta-analysis. Neurology 89(12):1220–1228CrossRefPubMed

10.

Ferro JM, Pinto F (2004) Poststroke epilepsy: epidemiology, pathophysiology and management. Drugs Aging 21(10):639–653CrossRefPubMed

11.

Berges S, Moulin T, Berger E et al (2000) Seizures and epilepsy following strokes: recurrence factors. Eur Neurol 43(1):3–8CrossRefPubMed

12.

Fisher RS, Acevedo C, Arzimanoglou A et al (2014) ILAE official report: a practical clinical definition of epilepsy. Epilepsia 55(4):475–482CrossRefPubMed

13.

Thurman DJ, Logroscino G, Beghi E et al (2017) The burden of premature mortality of epilepsy in high-income countries: a systematic review from the mortality task force of the international league against epilepsy. Epilepsia 58(1):17–26CrossRefPubMed

14.

Reith J, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS (1997) Seizures in acute stroke: Predictors and prognostic significance. The Copenhagen Stroke Study. Stroke 28(8):1585–1589CrossRefPubMed

15.

Labovitz DL, Hauser WA, Sacco RL (2001) Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology 57(2):200–206CrossRefPubMed

16.

Hamidou B, Aboa-Eboule C, Durier J et al (2013) Prognostic value of early epileptic seizures on mortality and functional disability in acute stroke: the Dijon Stroke Registry (1985–2010). J Neurol 260(4):1043–1051CrossRefPubMed

17.

Szaflarski JP, Rackley AY, Kleindorfer DO et al (2008) Incidence of seizures in the acute phase of stroke: a population-based study. Epilepsia 49(6):974–981CrossRefPubMedPubMedCentral

18.

Davalos A, De Cendra E, Molins A, Ferrandiz M, Lopez-Pousa S, Genis D (1992) Epileptic seizures at the onset of stroke. Cerebrovasc Dis 2:327–331CrossRef

19.

Arboix A, Comes E, Massons J, Garcia L, Oliveres M (1996) Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease. Neurology 47(6):1429–1435CrossRefPubMed

20.

Arboix A, Comes E, Garcia-Eroles L, Massons JB, Oliveres M, Balcells M (2003) Prognostic value of very early seizures for in-hospital mortality in atherothrombotic infarction. Eur Neurol 50(2):78–84CrossRefPubMed

21.

Arntz RM, Rutten-Jacobs LC, Maaijwee NA et al (2015) Poststroke epilepsy is associated with a high mortality after a stroke at young age: follow-up of transient ischemic attack and stroke patients and unelucidated risk factor evaluation study. Stroke 46(8):2309–2311CrossRefPubMed

22.

Allen CM (1983) Clinical diagnosis of the acute stroke syndrome. Q J Med 52(208):515–523PubMed

23.

Bamford J, Sandercock P, Jones L, Warlow C (1987) The natural history of lacunar infarction: the Oxfordshire Community Stroke Project. Stroke 18(3):545–551CrossRefPubMed

24.

de Jong G, van Raak L, Kessels F, Lodder J (2003) Stroke subtype and mortality. a follow-up study in 998 patients with a first cerebral infarct. J Clin Epidemiol 56(3):262–268CrossRefPubMed

25.

Beghi E, Carpio A, Forsgren L et al (2010) Recommendation for a definition of acute symptomatic seizure. Epilepsia 51(4):671–675CrossRefPubMed

26.

Lossius MI, Ronning OM, Slapo GD, Mowinckel P, Gjerstad L (2005) Poststroke epilepsy: occurrence and predictors—a long-term prospective controlled study (Akershus Stroke Study). Epilepsia 46(8):1246–1251CrossRefPubMed

27.

Achterberg S, Cramer MJ, Kappelle LJ et al (2010) Patients with coronary, cerebrovascular or peripheral arterial obstructive disease differ in risk for new vascular events and mortality: the SMART study. Eur J Cardiovasc Prev Rehabil 17(4):424–430CrossRefPubMed

28.

Stefanidou M, Das RR, Beiser AS et al (2017) Incidence of seizures following initial ischemic stroke in a community-based cohort: The Framingham Heart Study. Seizure 47:105–110CrossRefPubMed

29.

De Reuck J, Nagy E, Van Maele G (2007) Seizures and epilepsy in patients with lacunar strokes. J Neurol Sci 263(1–2):75–78CrossRefPubMed

30.

De Reuck J, Van Maele G (2009) Cognitive impairment and seizures in patients with lacunar strokes. Eur Neurol 61(3):159–163CrossRefPubMed

31.

Arboix A, Blanco-Rojas L, Marti-Vilalta JL (2014) Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke: translation of knowledge to prevention strategies. Expert Rev Neurother 14(3):261–276CrossRefPubMed

32.

Beghi E, D’Alessandro R, Beretta S et al (2011) Incidence and predictors of acute symptomatic seizures after stroke. Neurology 77(20):1785–1793CrossRefPubMed

33.

Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP (2009) Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke 40(6):2068–2072CrossRefPubMed

34.

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

Title: The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study
Authors: J. H. van Tuijl
E. P. M. van Raak
R. J. van Oostenbrugge
A. P. Aldenkamp
R. P. W. Rouhl
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 8/2018
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-8907-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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