Pathogenesis of seizures and epilepsy after stroke

Acta Epileptologica, Год журнала: 2022, Номер 4(1)

Опубликована: Янв. 4, 2022

Abstract Stroke is the most frequent cause of secondary epilepsy in elderly. The incidence cerebral stroke increasing with extension life expectancy, and prevalence post-stroke (PSE) rising. There are various seizure types after stroke, occurrence closely related to type location stroke. Moreover, clinical treatment difficult, which increases risk disability death, affects prognosis quality patients. Now more get attention medical profession, has been researchers have devoted seizures PSE basic research, hope a scientific unified guideline, give timely effective treatment, but exact pathophysiologic mechanism not yet formed conclusion. It found that ion channels, neurotransmitters, proliferation glial cells, genetics other factors involved development PSE. In this review, we discuss pathogenesis early-onset epileptic late-onset order provide basis for clinicians understand disease, expect ideas future exploration.

Язык: Английский

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Non-Excitatory Amino Acids, Melatonin, and Free Radicals: Examining the Role in Stroke and Aging

Antioxidants, Год журнала: 2023, Номер 12(10), С. 1844 - 1844

Опубликована: Окт. 10, 2023

The aim of this review is to explore the relationship between melatonin, free radicals, and non-excitatory amino acids, their role in stroke aging. Melatonin has garnered significant attention recent years due its diverse physiological functions potential therapeutic benefits by reducing oxidative stress, inflammation, apoptosis. been found mitigate ischemic brain damage caused stroke. By scavenging radicals damage, melatonin may help slow down aging process protect against age-related cognitive decline. Additionally, acids have shown possess neuroprotective properties, including antioxidant anti-inflammatory aging-related conditions. They can attenuate modulate calcium homeostasis, inhibit apoptosis, thereby safeguarding neurons induced processes. intracellular accumulation certain could promote harmful effects during hypoxia-ischemia episodes thus, blockade acid transporters involved be an alternative strategy reduce damage. On other hand, specifically mitochondrial reactive oxygen nitrogen species, accelerates cellular senescence contributes Recent research suggests a complex interplay actions converge on multiple pathways, regulation modulation reduction inflammation. These mechanisms collectively contribute preservation neuronal integrity functions, making them promising targets for interventions disorders.

Язык: Английский

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The risk of new-onset epilepsy and refractory epilepsy in older adult stroke survivors

Neurology, Год журнала: 2019, Номер 93(6)

Опубликована: Июль 11, 2019

Objective

Our study objectives were to identify factors associated with new-onset epilepsy and refractory among older adult stroke survivors evaluate the receipt of diagnostic care mortality for participants who developed epilepsy.

Methods

We conducted a population-based, retrospective cohort using linked, administrative health databases. The Ontario Stroke Registry was used patients 67 years hospitalized at designated center in Ontario, Canada, between April 1, 2003, March 31, 2009, previously free Multivariable Fine–Gray hazard models examine risk epilepsy, accounting competing death.

Results

Among 19,138 adults stroke, 210 (1.1%) 27 (12.9%) became antiepileptic drugs. Within 1 year diagnosis, 24 (11.4%) assessed EEG 19 (9.0%) MRI. In multivariable analysis, younger age thrombolysis significantly increased risk. Lesser severity anticoagulant medication also risk; however, these effects decreased over time. Younger female sex only 5 following 97 (46.2%) died any cause.

Conclusions

Older are less likely develop pharmacologically An estimated 86.6% deaths attributed causes other than or

Язык: Английский

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Risk Factors for Epilepsy After Thrombolysis for Ischemic Stroke: A Cohort Study

Frontiers in Neurology, Год журнала: 2020, Номер 10

Опубликована: Янв. 23, 2020

The effects of thrombolysis in seizure and epilepsy after acute ischemic stroke have been poorly explored. In this study, we examine risk factors consequences intravenous rt-PA for treatment stroke. a retrospective cohort study evaluate thrombolysis, as well the impact seizures outcome patients. our cohort, mean age patients was 67.2 years old (SD = 13.1) 79 them (51.6%) were male and. Initial NIHSS score 10.95 6.25). Three months 2.09 3.55). Eighty seven (56.9%) mRS 0-1 thrombolysis. Hemorrhagic transformation observed 22 (14.4%) Twenty-one (13.7%) had 15 (9.8%) developed Seizures independently associated with hemorrhagic (OR 3.26; 95% CI 1.08-9.78; p 0.035) ≥ 2 at 3 3.51; 1.20-10.32; 0.022). 3.55; 1.11-11.34; 0.033) 5.82; 1.45-23.42; 0.013) variables post-stroke epilepsy. independent risks poor 1.03; 1.01-1.06; 0.011), higher 1.08; 1.03-1.14; 0.001), 2.33; 1.11-4.76; 0.024), 3.07; 1.22-7.75; 0.018) large cortical area (ASPECTS ≤ 7) 2.04; 1.04-3.84; 0.036). Concluding, neurological impairment (but not before) remained or Moreover, that emerged an factor therapy 0.018).

Язык: Английский

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Antiseizure medications for post‐stroke epilepsy: A real‐world prospective cohort study

Brain and Behavior, Год журнала: 2021, Номер 11(9)

Опубликована: Авг. 22, 2021

Abstract Background and purpose The management of post‐stroke epilepsy (PSE) should ideally include prevention both seizure adverse effects; however, an optimal antiseizure medications (ASM) regimen has yet been established. this study is to assess recurrence, retention, tolerability older‐generation newer‐generation ASM for PSE. Methods This prospective multicenter cohort (PROgnosis Post‐Stroke Epilepsy [PROPOSE] study) was conducted from November 2014 September 2019 at eight hospitals. A total 372 patients admitted treated with discharge were recruited. Due the non‐interventional nature study, not adjusted followed standard hospital practices. primary outcome recurrence in receiving ASM. secondary outcomes retention regimens. Results Of PSE (median [IQR] age, 73 [64–81] years; 139 women [37.4%]), 36 older‐generation, 286 newer‐generation, 50 mixed‐generation In older‐ groups ( n = 322), 98 (30.4%) had recurrent seizures 91 (28.3%) switched during follow‐up (371 [347–420] days). Seizure lower compared (hazard ratio [HR], 0.42, 95%CI 0.27–0.70; p .0013). withdrawal change dosages (HR, 0.34, 95% CI 0.21–0.56, < .0001). Conclusions Newer‐generation possess advantages over prophylaxis clinical practice.

Язык: Английский

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Health equity integrated epilepsy care and research: A narrative review

Epilepsia, Год журнала: 2023, Номер 64(11), С. 2878 - 2890

Опубликована: Сен. 19, 2023

Abstract Background With the unanimous approval of Intersectoral Global Action Plan on epilepsy and other neurological disorders by World Health Organization in May 2022, there are strong imperatives to work towards equitable care. Aims Using as an entry point neurologic conditions, we discuss disparities faced marginalized groups including racial/ethnic minorities, Americans living rural communities, with low socioeconomic status. Materials Methods The National Institute Minority Disparities Research Framework (NIMHD) was used conduct a narrative review through health equity lens create adapted framework for propose approaches working Results In this review, identified priority populations (racial ethnic minority, rural‐residing, status persons epilepsy) outcomes (likelihood see neurologist, be prescribed antiseizure medications, undergo surgery, hospitalized) explore guide our focused literature search using PubMed. NIMHD framework, examined individual, interpersonal, community, societal level contributors across five domains: (1) behavioral, (2) physical/built environment, (3) sociocultural, (4) (5) healthcare system. We take approach initiatives that target modifiable factors impact advocate sustainable change populations. Discussion To improve equity, providers relevant stakeholders can improved care coordination, referrals access care, informatics interventions, education (i.e., providers, patients, communities). More broadly, reforms medical education, American insurance landscape. Conclusions Equitable should

Язык: Английский

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A Multifunctional Bioelectronic Device with Switchable Rigidity and Reconfigurable Shapes for Comprehensive Diagnosis

Advanced Electronic Materials, Год журнала: 2023, Номер 9(7)

Опубликована: Апрель 26, 2023

Abstract Soft bioelectronic devices have potential in medical applications, especially comprehensive diagnoses that rely on immovable equipment to acquire multiple physiological signals. Challenges for lie the opposite modulus demand multifunctional integration and biocompatibility, shape compatibility reducing implantation trauma covering target tissue. Here, this work reports a device endowed with switchable rigidity reconfigurable shapes by fast thermal response memory polymer substrate. The customizable substrate has melting temperature around body (≈38 °C) an ≈100 times drop (from MPa ≈700 kPa). realizes stacked layers fabrication rigid state self‐adaptive contact soft state. Shape reconfiguration allows be implanted through small incisions recover limited spaces envelop biosurfaces. Multiple physical, biochemical, electrophysiological signal sensing functions are integrated device, realized pH electrodes linear, stable, responses low‐impedance electrode. For some epilepsy pericardial effusion types single parameter fails distinguish, animal experiments demonstrate efficiency their diagnosis electrocorticogram assisted brain electrocardiogram fluid pH, respectively.

Язык: Английский

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Evidence Implicating Blood-Brain Barrier Impairment in the Pathogenesis of Acquired Epilepsy following Acute Organophosphate Intoxication

Journal of Pharmacology and Experimental Therapeutics, Год журнала: 2023, Номер 388(2), С. 301 - 312

Опубликована: Окт. 12, 2023

Organophosphate (OP) poisoning can trigger cholinergic crisis, a life-threatening toxidrome that includes seizures and status epilepticus. These acute toxic responses are associated with persistent neuroinflammation spontaneous recurrent (SRS), also known as acquired epilepsy. Blood-brain barrier (BBB) impairment has recently been proposed pathogenic mechanism linking OP intoxication to chronic adverse neurologic outcomes. In this review, we briefly describe the cellular molecular components of BBB, review evidence altered BBB integrity following intoxication, discuss potential mechanisms by which may promote dysfunction. We highlight complex interplay between dysfunction suggests positive feedforward interaction. Lastly, examine research from diverse models disease states suggest loss contribute epileptogenic processes. Collectively, literature identifies convergent justifies further mechanistic into how causes its role in pathogenesis SRS potentially other long-term sequelae. Such is critical for evaluating stabilization neuroprotective strategy mitigating OP-induced epilepsy possibly seizure disorders etiologies. SIGNIFICANCE STATEMENT: Clinical preclinical studies support link blood-brain epileptogenesis; however, causal relationship difficult prove. Mechanistic delineate relationships provide novel insights resulting organophosphate non-OP neurological conditions such cognitive impairment.

Язык: Английский

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Antiseizure Medications in Poststroke Seizures

Neurology, Год журнала: 2025, Номер 104(3)

Опубликована: Янв. 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.

Язык: Английский

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An automatic deep-learning approach for the prediction of post-stroke epilepsy after an initial intracerebral hemorrhage based on non-contrast computed tomography imaging

Quantitative Imaging in Medicine and Surgery, Год журнала: 2025, Номер 15(2), С. 1175 - 1189

Опубликована: Янв. 24, 2025

Post-stroke epilepsy (PSE) is a common and significant complication that often occurs after stroke, affects patients' prognosis overall quality of life. In recent years, non-contrast computed tomography (NCCT) has become the preferred method for clinical diagnosis intracerebral hemorrhage (ICH). This study aimed to develop validate triple deep-learning model, simply named, post-stroke network (PSENet), predict PSE in ICH patients based on NCCT. A total 1,130 (62 with 1,068 without PSE) who experienced an initial at our hospital were enrolled this study. Using five-fold cross-validation, all randomly divided into training validation sets ratio 4:1. Next, no-new-Net (nnU-Net) was used automatically segment subsequent quantitative analysis. model developed extract PSE-related features incorporate related cortical involvement (FCI) volume PSE. compared three models constructed using random forest. Model performance mainly evaluated area under curve (AUC). The nnU-Net had high Dice score 0.923. proposed PSENet, which incorporated multiple features, showed excellent diagnostic performance, accuracy 0.876, F1-score 0.621, recall 0.716, specificity 0.897, AUC 0.840, significantly surpassed baseline (AUC =0.787). Based findings, PSENet could be quickly first ICH, especially scenarios reliable information lacking admission.

Язык: Английский

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