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Post-stroke seizures: risk factors and management after ischemic stroke

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Abstract

Stroke is the leading cause of epilepsy in the elderly, ahead of degenerative diseases, tumors and head injuries. It constitutes a significant complication and a considerable comorbidity. The aim of our study was to describe the main factors implicated in the occurrence of post-stroke seizures and to identify the predictors of seizure recurrence. We conducted a descriptive, retrospective, monocentric study from January 2010 to December 2019, including patients who presented seizures following an ischemic stroke. We classified these seizures according to the International League Against Epilepsy (ILAE) into acute symptomatic seizures (ASS) if they occur within seven days of stroke, and unprovoked seizures (US) if they occur after more than one week. Clinical, para-clinical, therapeutic and follow-up data were statistically analyzed and compared. A total of 52 patients were included (39 men, 13 women; median age 55.1 years). 21 cases (40%) had ASS and the remaining 31 cases (60%) presented US. Young age below 65 years (71%), middle cerebral artery infarcts (83%), and cortical localization (87%) were the main factors depicted in our series. Parietal lobe infarction was more associated with US than ASS (p = 0.035). 24 patients (46%) have presented a recurrence of seizures (8/21 of ASS and 16/31 of US). The use of sodium valproate in monotherapy was identified as a recurrence risk factor (p = 0.013). In patients with post-stroke seizures, parietal lobe infarcts are more associated with US. We identified a higher risk of seizure recurrence in patients treated with sodium valproate monotherapy.

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References

  1. Holmes SG (1931) Selected writings of John Hughlings Jackson. Volume I: on epilepsy and epileptiform convulsions. J Am Med Assoc 97:1984–1985. https://doi.org/10.1001/jama.1931.02730260050031

    Article  Google Scholar 

  2. Wang JZ, Vyas MV, Saposnik G, Burneo JG (2017) Incidence and management of seizures after ischemic stroke: systematic review and meta-analysis. Neurology 89:1220–1228. https://doi.org/10.1212/WNL.0000000000004407

    Article  PubMed  Google Scholar 

  3. Holtkamp M, Beghi E, Benninger F, Kälviäinen R, Rocamora R, Christensen H et al (2017) European Stroke Organisation guidelines for the management of post-stroke seizures and epilepsy. Eur Stroke J 2:103–115. https://doi.org/10.1177/2396987317705536

    Article  PubMed  PubMed Central  Google Scholar 

  4. Beghi E, Carpio A, Forsgren L, Hesdorffer DC, Malmgren K, Sander JW et al (2010) Recommendation for a definition of acute symptomatic seizure. Epilepsia 51:671–675. https://doi.org/10.1111/j.1528-1167.2009.02285.x

    Article  PubMed  Google Scholar 

  5. Larrue V, von Kummer R, del Zoppo G, Bluhmki E (1997) Hemorrhagic transformation in acute ischemic stroke: potential contributing factors in the European Cooperative Acute Stroke Study. Stroke 28:957–960. https://doi.org/10.1161/01.STR.28.5.957

    Article  CAS  PubMed  Google Scholar 

  6. Fisher RS, Cross JH, D’Souza C, French JA, Haut SR, Higurashi N et al (2017) Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia 58:531–542. https://doi.org/10.1111/epi.13671

    Article  PubMed  Google Scholar 

  7. Lamy C, Domigo V, Semah F, Arquizan C, Trystram D, Coste J et al (2003) Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology 60:400–404. https://doi.org/10.1212/wnl.60.3.400

    Article  CAS  PubMed  Google Scholar 

  8. Labovitz DL, Hauser WA, Sacco RL (2001) Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology 57:200–206. https://doi.org/10.1212/wnl.57.2.200

    Article  CAS  PubMed  Google Scholar 

  9. Stefanidou M, Das RR, Beiser AS, Sundar B, Kelly-Hayes M, Kase CS et al (2017) Incidence of seizures following initial ischemic stroke in a community-based cohort: the Framingham Heart Study. Seizure 47:105–110. https://doi.org/10.1016/j.seizure.2017.03.009

    Article  PubMed  Google Scholar 

  10. Bryndziar T, Sedova P, Kramer NM, Mandrekar J, Mikulik R, Brown RD et al (2016) Seizures following ischemic stroke: frequency of occurrence and impact on outcome in a long-term population-based study. J Stroke Cerebrovasc Dis 25:150–156. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.09.008

    Article  PubMed  Google Scholar 

  11. Cordonnier C, Hénon H, Derambure P, Pasquier F, Leys D (2007) Early epileptic seizures after stroke are associated with increased risk of new-onset dementia. J Neurol Neurosurg Psychiatry 78:514–516. https://doi.org/10.1136/jnnp.2006.105080

    Article  PubMed  PubMed Central  Google Scholar 

  12. Vercueil L (2007) Crises d’épilepsie, épilepsies et accidents vasculaires cérébraux. Presse Med 36:176–181. https://doi.org/10.1016/j.lpm.2006.11.001

    Article  PubMed  Google Scholar 

  13. Xu MY (2019) Poststroke seizure: optimising its management. Stroke Vasc Neurol 4:48–56. https://doi.org/10.1136/svn-2018-000175

    Article  PubMed  Google Scholar 

  14. Devuyst G, Karapanayiotides T, Hottinger I, Van Melle G, Bogousslavsky J (2003) Prodromal and early epileptic seizures in acute stroke: Does higher serum cholesterol protect? Neurology 61:249–252. https://doi.org/10.1212/01.WNL.0000070410.68541.7E

    Article  CAS  PubMed  Google Scholar 

  15. Conrad J, Pawlowski M, Dogan M, Kovac S, Ritter MA, Evers S (2013) Seizures after cerebrovascular events: risk factors and clinical features. Seizure 22:275–282. https://doi.org/10.1016/j.seizure.2013.01.014

    Article  PubMed  Google Scholar 

  16. Misirli H, Özge A, Somay G, Erdoǧan N, Erkal H, Erenoǧlu NY (2006) Seizure development after stroke: seizure development after stroke. Int J Clin Pract 60:1536–1541. https://doi.org/10.1111/j.1742-1241.2005.00782.x

    Article  CAS  PubMed  Google Scholar 

  17. Graham NSN, Crichton S, Koutroumanidis M, Wolfe CDA, Rudd AG (2013) Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register. Stroke 44:605–611. https://doi.org/10.1161/STROKEAHA.111.000220

    Article  PubMed  Google Scholar 

  18. Arboix A, García-Eroles L, Massons JB, Oliveres M, Comes E (1997) Predictive factors of early seizures after acute cerebrovascular disease. Stroke 28:1590–1594. https://doi.org/10.1161/01.str.28.8.1590

    Article  CAS  PubMed  Google Scholar 

  19. Serafini A, Gigli GL, Gregoraci G, Janes F, Cancelli I, Novello S et al (2015) Are early seizures predictive of epilepsy after a stroke? Results of a population-based study. Neuroepidemiology 45:50–58. https://doi.org/10.1159/000382078

    Article  PubMed  Google Scholar 

  20. Huang C-W, Saposnik G, Fang J, Steven DA, Burneo JG (2014) Influence of seizures on stroke outcomes: a large multicenter study. Neurology 82:768–776. https://doi.org/10.1212/WNL.0000000000000166

    Article  PubMed  Google Scholar 

  21. Ferlazzo E, Gasparini S, Beghi E, Sueri C, Russo E, Leo A et al (2016) Epilepsy in cerebrovascular diseases: review of experimental and clinical data with meta-analysis of risk factors. Epilepsia 57:1205–1214. https://doi.org/10.1111/epi.13448

    Article  PubMed  Google Scholar 

  22. Zhang C, Wang X, Wang Y, Zhang J, Hu W, Ge M et al (2014) Risk factors for post-stroke seizures: a systematic review and meta-analysis. Epilepsy Res 108:1806–1816. https://doi.org/10.1016/j.eplepsyres.2014.09.030

    Article  PubMed  Google Scholar 

  23. Roivainen R, Haapaniemi E, Putaala J, Kaste M, Tatlisumak T (2013) Young adult ischaemic stroke related acute symptomatic and late seizures: risk factors. Eur J Neurol 20:1247–1255. https://doi.org/10.1111/ene.12157

    Article  CAS  PubMed  Google Scholar 

  24. Moalla KS, Damak M, Chakroun O, Farhat N, Daoud S, Hdiji O et al (2019) Incidence and predictors of post-stroke epilepsy. J Neurol Sci 405:114. https://doi.org/10.1016/j.jns.2019.10.649

    Article  Google Scholar 

  25. Goswami RP, Karmakar PS, Ghosh A (2012) Early seizures in first-ever acute stroke patients in India: incidence, predictive factors and impact on early outcome. Eur J Neurol 19:1361–1366. https://doi.org/10.1111/j.1468-1331.2012.03782.x

    Article  CAS  PubMed  Google Scholar 

  26. Jungehulsing GJ, Heuschmann PU, Holtkamp M, Schwab S, Kolominsky-Rabas PL (2013) Incidence and predictors of post-stroke epilepsy. Acta Neurol Scand 127:427–430. https://doi.org/10.1111/ane.12070

    Article  PubMed  Google Scholar 

  27. Heuts-van Raak L, Lodder J, Kessels F (1996) Late seizures following a first symptomatic brain infarct are related to large infarcts involving the posterior area around the lateral sulcus. Seizure 5:185–194. https://doi.org/10.1016/s1059-1311(96)80034-3

    Article  CAS  PubMed  Google Scholar 

  28. 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 315:1582–1587. https://doi.org/10.1136/bmj.315.7122.1582

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Tanaka T, Ihara M (2017) Post-stroke epilepsy. Neurochem Int 107:219–228. https://doi.org/10.1016/j.neuint.2017.02.002

    Article  CAS  PubMed  Google Scholar 

  30. 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 4:715–720

    Article  PubMed  PubMed Central  Google Scholar 

  31. Beghi E, D’Alessandro R, Beretta S, Consoli D, Crespi V, Delaj L et al (2011) Incidence and predictors of acute symptomatic seizures after stroke. Neurology 77:1785–1793. https://doi.org/10.1212/WNL.0b013e3182364878

    Article  CAS  PubMed  Google Scholar 

  32. Procaccianti G, Zaniboni A, Rondelli F, Crisci M, Sacquegna T (2012) Seizures in acute stroke: incidence, risk factors and prognosis. Neuroepidemiology 39:45–50. https://doi.org/10.1159/000338374

    Article  PubMed  Google Scholar 

  33. Kraus JA, Berlit P (1998) Cerebral embolism and epileptic seizures–the role of the embolic source. Acta Neurol Scand 97:154–159. https://doi.org/10.1111/j.1600-0404.1998.tb00629.x

    Article  CAS  PubMed  Google Scholar 

  34. Hauser WA, Kurland LT (1975) The epidemiology of epilepsy in Rochester, Minnesota, 1935 through 1967. Epilepsia 16:1–66. https://doi.org/10.1111/j.1528-1157.1975.tb04721.x

    Article  CAS  PubMed  Google Scholar 

  35. Lesser RP, Lüders H, Dinner DS, Morris HH (1985) Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 26:622–630. https://doi.org/10.1111/j.1528-1157.1985.tb05702.x

    Article  CAS  PubMed  Google Scholar 

  36. Redfors P, Holmegaard L, Pedersen A, Jern C, Malmgren K (2020) Long-term follow-up of post-stroke epilepsy after ischemic stroke: Room for improved epilepsy treatment. Seizure 76:50–55. https://doi.org/10.1016/j.seizure.2020.01.009

    Article  PubMed  Google Scholar 

  37. So EL, Annegers JF, Hauser WA, O’Brien PC, Whisnant JP (1996) Population-based study of seizure disorders after cerebral infarction. Neurology 46:350–355. https://doi.org/10.1212/wnl.46.2.350

    Article  CAS  PubMed  Google Scholar 

  38. Wang G, Jia H, Chen C, Lang S, Liu X, **a C et al (2013) Analysis of risk factors for first seizure after stroke in Chinese patients. BioMed Res Int 2013:1–9. https://doi.org/10.1155/2013/702871

    Article  Google Scholar 

  39. Tanaka T, Yamagami H, Ihara M, Motoyama R, Fukuma K, Miyagi T et al (2015) Seizure outcomes and predictors of recurrent post-stroke seizure: a retrospective observational cohort study. PLoS ONE 10:e0136200. https://doi.org/10.1371/journal.pone.0136200

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Kim HJ, Park KD, Choi K-G, Lee HW (2016) Clinical predictors of seizure recurrence after the first post-ischemic stroke seizure. BMC Neurol 16:212. https://doi.org/10.1186/s12883-016-0729-6

    Article  PubMed  PubMed Central  Google Scholar 

  41. Tomari S, Tanaka T, Ihara M, Matsuki T, Fukuma K, Matsubara S et al (2017) Risk factors for post-stroke seizure recurrence after the first episode. Seizure 52:22–26. https://doi.org/10.1016/j.seizure.2017.09.007

    Article  PubMed  Google Scholar 

  42. Arntz R, Rutten-Jacobs L, Maaijwee N, Schoonderwaldt H, Dorresteijn L, van Dijk E et al (2013) Post-stroke epilepsy in young adults: a long-term follow-up study. PLoS ONE 8:e55498. https://doi.org/10.1371/journal.pone.0055498

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Berges S, Moulin T, Berger E, Tatu L, Sablot D, Challier B et al (2000) Seizures and epilepsy following strokes: recurrence factors. Eur Neurol 43:3–8. https://doi.org/10.1159/000008120

    Article  CAS  PubMed  Google Scholar 

  44. AED for Post-Stroke Epilepsy Linked to Increased Death Risk. Medscape n.d. (2020) http://www.medscape.com/viewarticle/922822. Accessed 19 Jun 2020

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  1. Department of Neurology, Military Hospital of Instruction of Tunis, Mont Fleury, 1008, Tunis, Tunisia

    Asma Ouerdiene, Mariem Messelmani, Hajer Derbali, Malek Mansour, Jamel Zaouali, Nejiba Mrissa & Ridha Mrissa

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  1. Asma Ouerdiene
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Correspondence to Asma Ouerdiene.

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Ouerdiene, A., Messelmani, M., Derbali, H. et al. Post-stroke seizures: risk factors and management after ischemic stroke. Acta Neurol Belg 123, 145–152 (2023). https://doi.org/10.1007/s13760-021-01742-x

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