Immune Pathways in Etiology, Acute Phase, and Chronic Sequelae of Ischemic Stroke

Circulation Research, Journal Year: 2022, Volume and Issue: 130(8), P. 1167 - 1186

Published: April 14, 2022

Inflammation and immune mechanisms are crucially involved in the pathophysiology of development, acute damage cascades, chronic course after ischemic stroke. Atherosclerosis is an inflammatory disease, and, addition to classical risk factors, maladaptive lead increased Accordingly, individuals with signs inflammation or corresponding biomarkers have Anti-inflammatory drugs, such as IL (interleukin)-1β blockers, methotrexate, colchicine, represent attractive treatment strategies prevent vascular events Lately, COVID-19 pandemic shows a clear association between SARS-CoV2 infections cerebrovascular events. Furthermore, both innate adaptive systems influence cerebral cascades Neutrophils, monocytes, microglia, well T B lymphocytes each play complex interdependent roles that synergize remove dead tissue but also can cause bystander injury intact brain cells generate inflammation. Chronic systemic comorbid may unfavorably outcome stroke recurrence for further In addition, triggers specific depression, which turn promote infections. Recent research now increasingly addressing question extent long-term particular, complications poststroke dementia even depression.

Language: Английский

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Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management

Drugs & Aging, Journal Year: 2021, Volume and Issue: 38(4), P. 285 - 299

Published: Feb. 23, 2021

Stroke is the leading cause of seizures and epilepsy in older adults. Patients who have larger more severe strokes involving cortex, are younger, acute symptomatic intracerebral haemorrhage at highest risk developing post-stroke epilepsy. Prognostic models, including SeLECT CAVE scores, help gauge epileptogenesis. Early electroencephalogram blood-based biomarkers can provide information additional to clinical factors The management versus remote after stroke markedly different. choice an ideal antiseizure medication should not only rely on efficacy but also consider adverse effects, altered pharmacodynamics adults, influence underlying vascular co-morbidity. Drug–drug interactions, particularly those between medications anticoagulants or antiplatelets, treatment decisions. In this review, we describe epidemiology, factors, biomarkers, ischaemic haemorrhagic stroke. We discuss special considerations required for due age, co-morbidities, co-medication, vulnerability survivors.

Language: Английский

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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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Stroke‐related epilepsy

European Journal of Neurology, Journal Year: 2018, Volume and Issue: 26(1), P. 18 - 18

Published: Oct. 15, 2018

Stroke is the cause of about 10% all epilepsy and 55% newly diagnosed seizures among elderly. Although recent advances in acute stroke therapy have improved longevity, there has been a consequent rise prevalence stroke‐related ( STRE ). Many clinical studies make distinction between early (within 7 days onset stroke) late (beyond based on presumed pathophysiological differences. are thought to be consequence local metabolic disturbances without altered neuronal networks, occur when brain acquired predisposition for seizures. Overall, good prognosis, being well controlled by antiepileptic drugs. However, up 25% cases become drug resistant. can also result increased morbidity, longer hospitalization, greater disability at discharge resource utilization. Additional trials needed explore primary secondary prevention as provide high‐quality evidence efficacy tolerability drugs guide treatment . Robust pre‐clinical prediction models develop treatments prevent transformation infarcted tissue into an epileptic focus.

Language: Английский

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How to diagnose and treat post‐stroke seizures and epilepsy

Epileptic Disorders, Journal Year: 2020, Volume and Issue: 22(3), P. 252 - 263

Published: June 1, 2020

Abstract Stroke is one of the commonest causes seizures and epilepsy, mainly among elderly adults. This seminar paper aims to provide an updated overview post‐stroke epilepsy (PSE) offers clinical guidance anyone involved in treatment patients with stroke. The distinction between acute symptomatic occurring within seven days from stroke (early seizures) unprovoked afterwards (late crucial regarding their different risks recurrence. A single late seizure carries a risk recurrence as high 71.5% (95% confidence interval: 59.7–81.9) at ten years diagnostic PSE. Several characteristics are associated increased So far, there no evidence supporting administration antiepileptic drugs primary prevention, use PSE scarce.

Language: Английский

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Outcomes in Patients With Poststroke Seizures

JAMA Neurology, Journal Year: 2023, Volume and Issue: 80(11), P. 1155 - 1155

Published: Sept. 18, 2023

Published data about the impact of poststroke seizures (PSSs) on outcomes patients with stroke are inconsistent and have not been systematically evaluated, to authors' knowledge.

Language: Английский

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Poststroke seizure: optimising its management

Stroke and Vascular Neurology, Journal Year: 2018, Volume and Issue: 4(1), P. 48 - 56

Published: Dec. 9, 2018

Seizure after stroke or poststroke seizure (PSS) is a common and very important complication of stroke. It can be divided into early late seizure, depending on onset time the has been reported that ischaemic haemorrhagic accounts for about 11% all adult epilepsy cases 45% over 60 years age. However, there are no reliable guidelines in clinical practice regarding most fundamental issues PSS management. In recent an increased interest study which may give practitioners better picture how to optimise Studies have indicated two peaks occurrence—the first day 6–12 months Haemorrhagic stroke, cortical involvement, severity initial neurological deficit, younger patients (<65 age), family history seizures certain genetic factors carry higher risk PSS. The use continuous electroencephalogram demonstrated significant benefits capturing interictal ictal abnormalities, especially non-convulsive status epilepticus. Current available data was difference antiepileptic efficacy among drugs (AEDs) Levetiracetam lamotrigine studied newer generation AEDs best drug tolerance. purpose this review summarise advances research focus

Language: Английский

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Norwegian population‐based study of long‐term effects, safety, and predictors of response of vagus nerve stimulation treatment in drug‐resistant epilepsy: The NORPulse study

Epilepsia, Journal Year: 2021, Volume and Issue: 63(2), P. 414 - 425

Published: Dec. 21, 2021

Abstract Objective This study was undertaken to evaluate the efficacy of vagus nerve stimulation (VNS) over time, and determine which patient groups derive most benefit. Methods Long‐term outcomes are reported in 436 epilepsy patients from a VNS quality registry (52.8% adults, 47.2% children), with median follow‐up 75 months. Patients were stratified according evolution response into constant responders, fluctuating nonresponders. The effect evaluated at 6, 12, 24, 36, 60 Multivariate regression analysis used identify predictors response. Results cumulative probability ≥50% seizure reduction 60%; however, 15% showed course. Of those becoming 89.5% (230/257) did so within 2 years. A steady increase observed among 48.7% (19/39) seizure‐free 29.3% (39/133) ≥75% achieving these effects 2–5 Some (25%–<50%) 6 months positive predictor responder (odds ratio [OR] = 10.18, p < .0001) having years (OR 3.34, .03). without intellectual disability had ORs 3.34 3.11 5 years, respectively, an OR 6.22 being last observation. unchanged antiseizure medication observation period better rates (63.0% vs. 43.1%, .002) (63.4% 46.3%, .031) than whose modified. Responder higher for posttraumatic (70.6%, .048) poststroke epilepsies (75.0%, .05) other etiologies (46.5%). Significance Our data indicate that increases time there important clinical decision points 24 evaluating adjusting treatment. There should be selection candidates, as certain respond more favorably.

Language: Английский

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Seizures and epilepsy in patients with ischaemic stroke

Neurological Research and Practice, Journal Year: 2021, Volume and Issue: 3(1)

Published: Dec. 1, 2021

Abstract Background With the increased efficacy of stroke treatments, diagnosis and specific treatment needs patients with post-stroke seizures (PSS) epilepsy have become increasingly important. PSS can complicate a patients, worsen morbidity. This narrative review considers current guidelines, specifics antiseizure in as well state-of-the-art clinical imaging research epilepsy. Treatment to consider indications for medication individual social factors. Furthermore, potential interactions between treatments must be carefully considered. The relationship acute recanalizing therapy (intravenous thrombolysis mechanical thrombectomy) emergence is currently subject an intensive discussion. In subacute chronic phases, important necessary (anticoagulation, cardiac medication) need Among all forms prevention, primary prevention most intensively researched. includes specifically repurposing drugs that were not originally developed properties, such statins. are presently extensive basic research. Of interest role excitotoxicity blood–brain barrier disruption symptomatic late (> 1 week after stroke) periods. Current magnetic resonance focussing on glutamate diffusion-based estimation integrity aim elucidate pathophysiology principles epileptogenesis structural general. These approaches may also reveal new imaging-based biomarkers prediction Conclusion require performance risk assessments, accounting effectiveness side effects therapy. use intravenous thrombectomy associated PSS. Advances

Language: Английский

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Prognostic significance of the clinical and radiological haemorrhagic transformation subtypes in acute ischaemic stroke: A systematic review and meta‐analysis

European Journal of Neurology, Journal Year: 2022, Volume and Issue: 29(11), P. 3449 - 3459

Published: July 5, 2022

The aim was to investigate the associations of haemorrhagic transformation (HT) and its clinical radiological subtypes with functional outcome, mortality, early neurological deterioration (END) complications in patients acute ischaemic stroke (AIS).A systematic review meta-analysis observational studies on overall HT, HT (asymptomatic intracerebral haemorrhage [aICH] symptomatic [sICH]) or (haemorrhagic infarction [HI-1 HI-2] parenchymal [PH-1 PH-2]) prognosis AIS performed. PubMed, Web Science Embase were systematically searched. Random effects models used calculate pooled estimates.Fifty-one 100,510 meta-analysis. Overall associated worse outcome (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.55-2.90), increased mortality (OR 1.87, CI 1.52-2.30), END 2.35, 1.46-3.77), early-onset seizures 2.58, 1.63-4.10) post-stroke epilepsy 2.23, 1.11-4.49). For subtypes, sICH remained significantly aforementioned poor prognoses except epilepsy, aICH but unrelated mortality. PH (especially PH-2) strongly prognosis. HI-2 HI-1 a lower risk END.Regardless whether undergo thrombolysis thrombectomy, are substantially complications. presence is related independent impairs independence, does not cause impairment.

Language: Английский

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