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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Adult epilepsy

The Lancet, Journal Year: 2023, Volume and Issue: 402(10399), P. 412 - 424

Published: July 1, 2023

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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The aetiologies of epilepsy

Epileptic Disorders, Journal Year: 2021, Volume and Issue: 23(1), P. 1 - 16

Published: Feb. 1, 2021

Abstract The identification of the aetiology a patient's epilepsy is instrumental in diagnosis, prognostic counselling and management epilepsies. Indeed, can be important for determining recurrence risk single seizures so making diagnosis epilepsy. Here, we divide aetiologies into six categories: structural, genetic, infectious, metabolic, immune (all which are part International League Against Epilepsy [ILAE] classification system) neurodegenerative (which have considered separately because its growing importance epilepsy). These not mutually exclusive categories many fall more than one category. genetic factors probably play role, to varying degrees, all people with In each categories, discuss what regard as most aetiologies; being determined only by prevalence but also clinical significance. introduction contains information suitable level 1 competency (entry level), whilst subsequent sections contain aimed at 2 (proficiency level) new ILAE competency‐based curriculum. As move towards precision medicine targeted therapies, will an even greater role

Language: Английский

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Ferroptosis and Its Potential Role in the Nervous System Diseases

Journal of Inflammation Research, Journal Year: 2022, Volume and Issue: Volume 15, P. 1555 - 1574

Published: March 1, 2022

Ferroptosis is a novel regulated cell death characterized by metabolic disorders and iron-dependent oxidative destruction of the lipid bilayer. It primarily caused imbalance oxidation anti-oxidation in body precisely numerous factors pathways inside outside cell. Recent studies have indicated that ferroptosis plays vital role pathophysiological process multiple systems including nervous system. may be closely linked to occurrence development neurodegenerative diseases, strokes, brain tumors. also involved development, maturation, aging Therefore, this study aims investigate ferroptosis's regulatory mechanism summarize its research progress pathogenesis treatment neurological diseases. This would allow for ideas basic clinical

Language: Английский

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Drug-resistant epilepsy: Definition, pathophysiology, and management

Journal of the Neurological Sciences, Journal Year: 2023, Volume and Issue: 452, P. 120766 - 120766

Published: Aug. 14, 2023

Language: Английский

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Inflammation Mediated Epileptogenesis as Possible Mechanism Underlying Ischemic Post-stroke Epilepsy

Frontiers in Aging Neuroscience, Journal Year: 2021, Volume and Issue: 13

Published: Dec. 13, 2021

Post-stroke Epilepsy (PSE) is one of the most common forms acquired epilepsy, especially in elderly population. As people get increasingly older, number stroke patients expected to rise and concomitantly with PSE. Although many are affected by post-ischemic epileptogenesis, not much known about underlying pathomechanisms resulting development chronic seizures. A hypothesis that persistent neuroinflammation glial scar formation cause aberrant neuronal firing. Here, we summarize clinical features PSE describe detail inflammatory changes after an ischemic as well reported epilepsy. Moreover, discuss alterations disturbances blood-brain-barrier leakage, astrogliosis, extracellular matrix both, In end, provide overview commonalities reactions cellular processes environment epileptic brain how these research questions should be addressed future.

Language: Английский

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Predictors of Pharmaco-Resistance in Patients with Post-Stroke Epilepsy

Brain Sciences, Journal Year: 2021, Volume and Issue: 11(4), P. 418 - 418

Published: March 26, 2021

Objectives: The study aimed to explore the clinical predictors of pharmaco-resistance in patients with post-stroke epilepsy (PSE). Methods: Patients secondary cerebral infarct or spontaneous intracerebral hemorrhage were included. outcome was occurrence defined as failure adequate trials two tolerated and appropriately chosen used antiseizure medication schedules, whether monotherapies combination, achieve sustained seizure freedom. Results: One-hundred fifty-nine PSE a median follow-up 5 (3–9) years mean age at stroke onset 56.7 (14.9) years, 104 (65.4%) males. In cohort, 29 participants pharmaco-resistant. Age [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.93–0.99; p = 0.044], history (OR 2.95, CI 1.06–8.24; 0.039), severe 5.43, 1.82–16.16; 0.002), status epilepticus initial presentation 7.90, 1.66–37.55; 0.009), focal bilateral tonic-clonic seizures 3.19, 1.16–8.79; 0.025) independent treatment refractoriness. Conclusions: Pharmaco-resistance developed approximately 20% associated younger onset, type severity, occurrence, types.

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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Learning prevalent patterns of co-morbidities in multichronic patients using population-based healthcare data

Scientific Reports, Journal Year: 2024, Volume and Issue: 14(1)

Published: Jan. 25, 2024

Abstract The prevalence of longstanding chronic diseases has increased worldwide, along with the average age population. As a result, an increasing number people is affected by two or more conditions simultaneously, and healthcare systems are facing challenge treating multimorbid patients effectively. Current therapeutic strategies suited to manage each condition separately, without considering whole clinical patient. This approach may lead suboptimal outcomes system inefficiencies (e.g. redundant diagnostic tests inadequate drug prescriptions). We develop novel methodology based on joint implementation data reduction clustering algorithms identify patterns that likely co-occur in multichronic patients. analyse from large adult population living Tuscany (Italy) 2019 which was stratified sex classes. Results demonstrate (i) cardio-metabolic, endocrine, neuro-degenerative represent stable pattern multimorbidity, (ii) disease vary across ages between women men. Identifying most common profiles can help tailor medical protocols patients’ needs reduce costs. Furthermore, analysing temporal refine risk predictions for evolutive conditions.

Language: Английский

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