Pathophysiology, Diagnosis, Prognosis, and Prevention of Poststroke Epilepsy

Neurology, Journal Year: 2024, Volume and Issue: 102(11)

Published: May 18, 2024

Poststroke epilepsy (PSE) is associated with higher mortality and poor functional cognitive outcomes in patients stroke. With the remarkable development of acute stroke treatment, there a growing number survivors PSE. Although approximately 10% develop PSE, given significant burden worldwide, PSE problem survivors. Therefore, attention health policymakers funding are required to promote prevention research. The current definition includes unprovoked seizures occurring more than 7 days after onset, high recurrence risks seizures. However, pathologic cascade not uniform, indicating need for tissue-based approach rather time-based one distinguish early from late EEG commonly used tool diagnostic work-up findings during phase can potentially stratify risk subsequent predict poststroke epileptogenesis. Recent reports suggest that cortical superficial siderosis, which may be involved epileptogenesis, promising marker By incorporating such markers, future risk-scoring models could guide treatment strategies, particularly primary prophylaxis To date, drugs prevent epileptogenesis lacking. challenge involves substantial cost due difficulty reliably enrolling who There is, therefore, critical determine reliable biomarkers goal able use them trial enrichment as surrogate outcome measure Moreover, seizure essential decline Further elucidation factors contribute eagerly awaited. Meanwhile, regimen antiseizure medications should based on individual cardiovascular risk, psychosomatic comorbidities, concomitant medications. This review summarizes understanding its risks, prognostic models, prophylaxis, strategies secondary suggests advance research

Language: Английский

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Activated protein C: A potential therapeutic target of post-stroke epileptogenesis

Epilepsy & Behavior, Journal Year: 2025, Volume and Issue: 164, P. 110233 - 110233

Published: Jan. 18, 2025

Language: Английский

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Performance of GLIM with different nutrition risk screening tools in predicting 90‐day mortality in critically ill adults with acute stroke: A comparison study

Journal of Parenteral and Enteral Nutrition, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 8, 2025

The Global Leadership Initiative on Malnutrition (GLIM) proposes a diagnostic process for malnutrition, including initial screening with nutrition tools, followed by evaluation. This study aimed to compare the performance of GLIM different tools in predicting 90-day mortality adults who are critically ill acute stroke. A comparative was conducted 308 (who ill) Multiple were evaluated upon admission. Nutrition status assessed using criteria. predictive analyzed Cox regression. prevalence malnutrition ranged from 17.86% 28.25%, depending used classification. During follow-ups, 112 (36.36%) deaths occurred. effectively predicted mortality, and modified Nutritional Risk Critically Ill (mNUTRIC) demonstrating best ability [Hazard Ratio: 2.807 (1.816-4.339)]. identified mNUTRIC demonstrates good predict criteria anticipate might guide interventions, important implications clinical practice research.

Language: Английский

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Risk of Poststroke Epilepsy Among Young Adults With Ischemic Stroke or Intracerebral Hemorrhage

JAMA Neurology, Journal Year: 2025, Volume and Issue: unknown

Published: April 14, 2025

Importance Poststroke epilepsy (PSE) is a major complication among young adults and associated with problems functional recovery daily life. Although scores have been developed to predict risk of PSE, they not validated patients stroke at age. Objectives To investigate both the factors for PSE age validate current cohort adults. Design, Setting, Participants This study used data from ODYSSEY (Observational Dutch Young Symptomatic Stroke Study), prospective conducted 17 hospitals in Netherlands between May 27, 2013, March 3, 2021, follow-up until February 28, 2024. included 1388 consecutive aged 18 49 years neuroimaging-proven ischemic or intracerebral hemorrhage (ICH) without history epilepsy. Statistical analysis took place June August Exposure First-ever ICH. Main Outcomes Measures was defined as least 1 remote symptomatic seizure (>7 days). Cumulative incidence functions were calculate 5-year PSE. Fine-Gray regression models identify (age, sex, clinical stroke, neuroimaging variables). The performances SeLECT (severity large-artery atherosclerosis, early seizure, cortical involvement, territory middle cerebral artery) 2.0 score (for stroke) CAVE (cortical age, bleeding volume, seizure) ICH) assessed C statistics calibration bar plots. Results (ischemic 1231 [88.7%]; ICH, 157 [11.3%]; median 44.1 [IQR, 38.0-47.4 years]; 736 men [53.0%]; follow-up, 5.3 3.4-7.4 years]), whom 57 (4.1%) cumulative 3.7% (95% CI, 0.2%-4.8%) after 7.6% 3.5%-11.8%) Factors an acute (<7 days) (hazard ratio [HR], 10.83 [95% 2.05-57.07]; P = .005) involvement (HR, 5.35 1.85-15.49]; .002). only factor ICH 8.20 2.22-30.25]; statistic 0.78 0.71-0.84) 0.83 0.76-0.90) score, good scores. Conclusion suggests that relatively low similar variables existing scores, which can therefore also be applied stroke. Future trials should optimal primary secondary prophylaxis high risk.

Language: Английский

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Evobrutinib mitigates neuroinflammation after ischemic stroke by targeting M1 microglial polarization via the TLR4/Myd88/NF-κB pathway

Molecular Medicine, Journal Year: 2025, Volume and Issue: 31(1)

Published: April 22, 2025

Abstract Background Evobrutinib, a third-generation Bruton's tyrosine kinase (BTK) inhibitor, shows great promise for treating neuroinflammatory diseases due to its small molecular size, ease of absorption, and ability cross the blood–brain barrier. Although previous studies have confirmed significant BTK expression in microglia, potential Evobrutinib treat ischemic stroke by modulating microglial function underlying mechanisms remain be elucidated. Methods Male C57BL/6 mice with cerebral ischemia was established evaluate effects oral treatment. Assessments included TTC staining, behavioral experiments, pathological examinations were used injury. Western Blot, flow cytometry, qPCR employed monitor changes pBTK microglia impact on neuroinflammation following stroke. In vitro, primary generated determine TLR4/ Myd88/NF-κB pathway polarization subtypes. Results The is upregulated under conditions oxygen–glucose deprivation (OGD). treatment not only reduced infarct volume but also ameliorated damage facilitated neurological recovery. Flow cytometry revealed that decreased inflammatory cell infiltration promoted M2 post-stroke. vitro demonstrated downregulated proportion pro-inflammatory curtailed secretion factors OGD conditions. Mechanistically, attenuated OGD-induced upregulation TLR4/Myd88/NF-κB expression, an effect further enhanced addition TLR4 inhibitor TAK242. Conclusions inhibits activation reducing M1 microglia-mediated alleviating injury This mechanistically linked inhibition TLR4/Myd88/NF-κB-mediated microglia. Graphical abstract improves ischemia, alleviates inhibiting through pathway.

Language: Английский

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Antiseizure Medications in Poststroke Seizures

Neurology, Journal Year: 2025, Volume and Issue: 104(3)

Published: Jan. 14, 2025

The most effective antiseizure medications (ASMs) for poststroke seizures (PSSs) remain unclear. We aimed to determine outcomes associated with ASMs in people PSS. systematically searched electronic databases studies on patients PSS ASMs. Our were seizure recurrence, adverse events, drug discontinuation rate, and mortality. assessed the risk of bias using Cochrane Risk Bias tool randomized controlled trials Of In Non-randomized Studies Interventions tools. Using levetiracetam as reference treatment, we conducted a frequentist network meta-analysis determined certainty evidence Grading Recommendations Assessment, Development, Evaluation methodology. search yielded 15 (3 randomized, 12 nonrandomized, N = 18,676 (121 early 18,547 late seizures), 60% male, mean age 69 years) comparing 13 Three had moderate high bias. Seizure recurrence was 24.8%. Compared levetiracetam, very low-certainty suggested that phenytoin higher recurrences (odds ratio [OR] 7.3, 95% CI 3.7-14.5) more events (OR 5.2, 1.2-22.9). Low-certainty carbamazepine 1.8, 1.5-2.2) 1.9, 1.4-2.8) rates. Moderate high-certainty valproic acid 4.7, 3.6-6.3) 8.3, 5.7-11.9) mortality Considering all treatments GRADE approach treatment ranking, eslicarbazepine, lacosamide, fewest recurrences. Low lamotrigine discontinuations, whereas exhibited low rates moderate-certainty evidence. found may be safe tolerable Despite ASM use, rate remains population. Owing confounding risks, these findings should interpreted cautiously. PROSPERO: CRD42022363844.

Language: Английский

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Risk factors of posthemorrhagic seizure in spontaneous intracerebral hemorrhage

Neurosurgical Review, Journal Year: 2025, Volume and Issue: 48(1)

Published: Jan. 23, 2025

Language: Английский

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Robot-assisted puncture versus conservative treatment for severe brainstem hemorrhage: clinical outcomes comparison with experience of 138 cases in a single medical center

World Journal of Emergency Surgery, Journal Year: 2025, Volume and Issue: 20(1)

Published: Feb. 25, 2025

The application of robot-assisted surgical technology in treating brainstem hemorrhage has garnered increasing attention. Treatments such as stereotactic hematoma aspiration and neuroendoscopic surgery are becoming more prevalent China. aim this study is to provide a detailed comparative analysis the clinical effects puncture versus traditional conservative treatment, offering scientific basis for optimizing treatment plans improving patient outcomes. A retrospective observational was conducted from January 2019 December 2023 at single neurosurgery center. total 138 patients with severe were included, 103 group 35 group.ROSA drainage precise neurosurgical procedure involving pre-surgical evaluations examinations, including cranial CT, determine hemorrhage's location, extent, severity. Baseline data extracted hospital's electronic medical record system, demographics, history, characteristics. Statistical performed compare outcomes between two groups. baseline characteristics both groups similar, no significant differences age, gender, smoking alcohol consumption, or other relevant factors. median stay time longer (21.0 days) compared (15.0 days), difference (p = 0.004). cost hospitalization also higher (105231.0 yuan) (55221.5 yuan), < 0.001). mortality rate robot assisted significantly lower than that group, significant. Additionally, had discharge volume trend towards better outcomes, measured by Glasgow Coma Scale (GCS) modified Rankin (mRS) scores. results suggest may offer improved treatment. precision accuracy ROSA contribute reduced complications. While potential long-term healthcare costs should be considered when evaluating cost-effectiveness approach. Further research needed validate these findings larger, multicenter studies explore benefits different subpopulations hemorrhage. This provides preliminary evidence complications, although taken into account. Future further innovative

Language: Английский

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The Impact of Age on Outcomes in Seizure Hospitalizations—Analysis of a National Sample

Neurology International, Journal Year: 2025, Volume and Issue: 17(3), P. 39 - 39

Published: March 4, 2025

Objective: Seizures are a critical public health issue, with incidence rising significantly after age 50. Using this inflection point, we divided patients into two groups to examine the impact of on patient characteristics and hospitalization outcomes for seizures. Methods: 2021 National Inpatient Sample (NIS), nationally representative database, conducted retrospective cohort analysis adult aged ≥18 years admitted principal diagnosis Patients were groups: 18–49 ≥50 years. Outcomes included in-hospital mortality, length stay, hospital charges. Multivariate logistic linear regression models adjusted confounders employed assess association between outcomes. Results: The 211,055 patients, 59% Older more likely have Medicare coverage (66% vs. 16%, p < 0.01), reside in south (41% 38%, higher proportion White individuals (62% 54%, 0.01). Younger be Hispanic (15% 9%, urban hospitals (96% 94%, treated at teaching (84% 79%, After adjusting confounders, older adults had over twice odds mortality compared younger (adjusted OR 2.17; 95% CI, 1.61–2.92; They also experienced longer stays (mean difference 0.7 days; 0.54–0.92; 0.01) charges increase USD 4322; 1914–6731; Significance: Age is an independent predictor hospitalizations, costs seizure-related admissions. These findings underscore need age-specific management strategies improve optimize healthcare resource utilization

Language: Английский

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Research Progress of Post-Stroke Epilepsy: Pathophysiology, Diagnosis, Treatment and Prognosis

Advances in Clinical Medicine, Journal Year: 2025, Volume and Issue: 15(03), P. 174 - 183

Published: Jan. 1, 2025

Language: Английский

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