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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Differences in patterns of outpatient epilepsy‐specific medication initiation after acute ischemic stroke in the Medicare population

Epilepsia, Journal Year: 2025, Volume and Issue: unknown

Published: April 4, 2025

Acute ischemic stroke (AIS) is a leading hospitalization cause and significantly contributes to seizures among older adults. We examined outpatient epilepsy-specific medication (ESM) initiation patterns after AIS discharge in adults 65 years older, trends over time (by stratifying the analysis from 2013 2021), racial/ethnic differences. analyzed nationwide administrative claims data for 20% sample of US Medicare beneficiaries (enrolled Traditional Parts A, B, D at least 12 months before admission) aged ≥65 hospitalized between 2021. estimated cumulative incidence ESM within 90 days discharge, with mortality as competing risk censoring person if individuals experienced an inpatient readmission. described drug type stratified our by race, ethnicity, geographic region, hospital year discharge. Of 128 174 community-dwelling 2435 (1.9%, 95% confidence interval [CI] = 1.8%-2.0%) initiated 90-day follow-up period levetiracetam was most common across all (81%). Mean age 79 (range 65-110), 56% were female, 81% non-Hispanic White, 10% Black/African American, 5% Hispanic, 3% Asian. The overall 1.4% (95% CI 1.3%-1.4%); it 1.8% 1.6%-2.1%) 1.9% 1.6%-2.3%) 1.2% 1.2%-1.3%) White beneficiaries. also varied Census division, 1.0% .8-1.3; West North Central) 1.5% 1.3%-1.8%; East South Central). observed increase time, 1.0%-1.5%) 1.7% 1.5%-1.9%) 1.6% 1.4%-1.8%) 65-70-year group decreased groups. American Hispanic had higher post-AIS than Whites.

Language: Английский

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Poststroke Seizure and Epilepsy: A Review of Incidence, Risk Factors, Diagnosis, Pathophysiology, and Pharmacological Therapies

Oxidative Medicine and Cellular Longevity, Journal Year: 2022, Volume and Issue: 2022, P. 1 - 15

Published: Oct. 26, 2022

Stroke is the most common cause of epilepsy and ultimately leads to a decrease in quality life those affected. Ischemic hemorrhagic strokes can both lead poststroke (PSE). Significant risk factors for PSE include $\text{age}<65$ age less than 65 years, stroke severity measured by National Institutes Health Scale (NIHSS), cortical involvement, genetic such as TRPM6 polymorphism. The diagnosis made using imaging modalities, blood biomarkers, prognostic criteria. Electroencephalography (EEG) currently gold standard diagnose PSE, while new combinations modalities are being tested increase diagnostic specificity. This literature review uncovers newly found mechanism pathology epilepsy. pathogenesis early-onset late-onset characterized sequelae neuronal cellular hypoxia disruption blood-brain barrier, respectively. Interleukin-6 responsible increasing activity glial cells, causing gliosis hyperexcitability neurons. Epinephrine, high-mobility group protein B1, downregulation CD32, upregulation HLA-DR impact inhibiting normal immune response. Decreased levels neuropeptide Y, neurotransmitter, act through multiple unique mechanisms, intracellular Ca2+ accumulation acting an anti-inflammatory, also implemented worsening progression Additionally, CA1 hippocampal resonant neurons that theta oscillation associated with Hypertensive small vessel disease may have implication temporal lobe occult microinfarctions. Furthermore, this highlights potential use statins primary prophylaxis against studies demonstrating reduction incidence alone, combination antiepileptic drugs (AEDs), aspirin. evidence strongly suggests second generation AEDs superior treatment method PSE. Data from numerous demonstrate their relative lack significant drug interactions, increased tolerability, superiority maintaining seizure-free status.

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 (&amp;gt;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 (&amp;lt;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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Efficacy and safety of antiseizure medication in post-stroke epilepsy

Seizure, Journal Year: 2022, Volume and Issue: 100, P. 109 - 114

Published: July 8, 2022

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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Comparative risk of major health events among individuals prescribed different antiseizure medications following ischemic stroke

Epilepsia, Journal Year: 2025, Volume and Issue: unknown

Published: March 11, 2025

Abstract Objective The aim of this study was to compare the risk seizure, recurrent stroke, fall or fracture, and mortality in individuals prescribed different antiseizure medications (ASMs) following an ischemic stroke. Methods We identified all patients admitted a Victorian public private hospital with principal diagnosis incident stroke between 2013 2017 dispensed ASM within 12 months discharge. Cox proportional hazards regression used estimate cause‐specific rehospitalization emergency department visits (seizure, stroke) all‐cause over 2‐year period. Inverse probability treatment weighting applied each model adjust for baseline covariates. Results Of 19 601 hospitalized 897 initiated months. More than three quarters were on non‐enzyme‐inducing (78.0%). Levetiracetam (41.9%), valproate (28.4%), carbamazepine (11.4%) commonly initial ASMs. Non‐enzyme‐inducing ASMs demonstrated similar seizure (hazard ratio [HR] = .93, 95% confidence interval [CI] .63–1.37), fracture (HR 1.47, CI .92–2.34), .83; .52–1.33), .96; .69–1.32) compared enzyme‐inducing However, when grouped as separate class, 1.67, 1.04–2.71) showed higher Significance At population level, types no significant differences hospitalization presentation 2 years presentation, suggesting short‐term health outcomes real‐world setting. Future research should investigate decision‐making around choice survivors examine impact long‐term exposure outcomes.

Language: Английский

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Impact of Seizure Recurrence on 1-Year Functional Outcome and Mortality in Patients With Poststroke Epilepsy

Neurology, Journal Year: 2022, Volume and Issue: 99(4)

Published: May 4, 2022

Background and Objectives

The functional outcome mortality of patients with poststroke epilepsy (PSE) have not been assessed in a prospective study. Previous reports suggested that PSE may suffer from prolonged deterioration after seizure. In this study, we prospectively investigated the analyzed effect seizure recurrence on outcomes.

Methods

This is part Prognosis Post-Stroke Epilepsy multicenter, observational cohort where 392 (at least 1 unprovoked more than 7 days onset last symptomatic stroke) were followed for at year 8 hospitals Japan. study included only first-ever their decline year. Functional was defined as an increase modified Rankin Scale (mRS) score compared baseline, excluding death. associations between outcomes statistically.

Results

A total 211 (median age 75 years; median mRS 3) identified. At year, 50 (23.7%) experienced recurrence. Regarding outcomes, 25 (11.8%) demonstrated 20 (9.5%) had died. Most died pneumonia or cardiac disease (7 each), no known causes death directly related to recurrent seizures. Seizure significantly associated (odds ratio [OR] 2.96, 95% CI 1.25–7.03, p = 0.01), even adjusting potential confounders (adjusted OR 3.26, 1.27–8.36, but (OR 0.79, 0.25–2.48, 0.68). Moreover, there significant trend seizures likely (8.7%, 20.6%, 28.6% none, 1, 2 seizures, respectively; 0.006).

Discussion

One-year poor. outcome, mortality. Further studies are needed ascertain whether early adequate antiseizure treatment can prevent PSE.

Language: Английский

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Association of Cortical Superficial Siderosis with Post‐Stroke Epilepsy

Annals of Neurology, Journal Year: 2022, Volume and Issue: 93(2), P. 357 - 370

Published: Sept. 1, 2022

Objective To assess whether post-stroke epilepsy (PSE) is associated with neuroimaging findings of hemosiderin in a case–control study, and the addition markers improves risk stratification models PSE. Methods We performed post-hoc analysis PROgnosis POST-Stroke Epilepsy study enrolling PSE patients at National Cerebral Cardiovascular Center, Osaka, Japan, from November 2014 to September 2019. was diagnosed when one unprovoked seizure experienced >7 days after index stroke, as proposed by International League Against Epilepsy. As controls, consecutive acute stroke no history or absence any late continuing antiseizure medications least 3 months were retrospectively enrolled during same period. examined cortical microbleeds superficial siderosis (cSS) using gradient-echo T2*-weighted images. A logistic regression model ridge penalties tuned 10-fold cross-validation. added item cSS existing (SeLECT CAVE) for predicting evaluated performance new models. Results The included 180 (67 women; median age 74 years) 1,183 controls (440 years). frequency higher than control groups (48.9% vs 5.7%, p < 0.0001). Compared models, (SeLECT-S CAVE-S) demonstrated significantly better predictive (net reclassification improvement 0.63 [p = 0.004] SeLECT-S 0.88 0.001] CAVE-S testing data). Interpretation Cortical PSE, stratifying survivors high ANN NEUROL 2023;93:357–370

Language: Английский

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Perampanel in post-stroke epilepsy: Clinical practice data from the PERampanel as Only Concomitant antiseizure medication (PEROC) study

Journal of the Neurological Sciences, Journal Year: 2024, Volume and Issue: 462, P. 123106 - 123106

Published: June 21, 2024

Language: Английский

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