Occurrence and risk factors of unprovoked epileptic seizures in ischaemic stroke patients

Czech version

Authors: P. Janský ¹; T. Růžičková ¹; ; A. Olšerová ¹; J. Reichl ²; M. S. Vosko ³; L. Šťovíčková ¹; J. Paulasová-Schwabová ¹; V. Šulc ¹; H. Magerová ¹; A. Kalina ¹; D. Kala ⁴; J. Otáhal ⁴; P. Marusič ¹; M. R. Vosko ⁴; A. Tomek
Authors‘ workplace: Department of Neurology, Second, Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic ¹; Department of Neurology 2, Kepler, Universitätsklinikum, Med Campus III, Linz, Austria ²; Technical University of Munich, School of Medicine, Germany ³; Institute of Physiology, Czech, Academy of Sciences, Prague, Czech, Republic ⁴
Published in: Cesk Slov Neurol N 2020; 83/116(3): 278-284
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2020278

Overview

Aim: The aim of our study was to determine the occurrence of unprovoked epileptic seizures in ischaemic stroke (IS) patients and compare their association with SeLECT score risk factors (IS severity, large-artery atherosclerosis, acute symptomatic epileptic seizures in association with the initial IS, cortical localization of the lesion, the involvement of the middle cerebral artery territory).

Patients and methods: Retrospective analysis of consecutive supratentorial IS survivors with a negative history of epilepsy, admitted to two major comprehensive stroke centers in the Czech Republic and Austria in one year period (2015). The follow-up information was collected from available medical documentation, using a structured telephone questionnaire and patients visits.

Results: 315 patients were included (59% men, median age 69 years, median National Institutes of Health Stroke Scale 4, intravenous thrombolysis 29.2%, mechanical thrombectomy 6.3%). Unprovoked epileptic seizures occurred in 24 patients (7.6%), the median follow-up period was 3.3 years. The seizure and seizure-free groups differed significantly in cortical involvement of the ischaemic lesion (70.8 vs. 38.5%; P = 0.002), a significant difference in the rest of SeLECT score risk factors was not found.

Conclusions: Unprovoked epileptic seizures occurred in 7.6% of IS survivors during the median follow-up period of 3.3 years. Cortical involvement of the ischaemic lesion was the only SeLECT score parameter with a significant difference between seizure and seizure-free groups.

Keywords:

risk factor – incidence – ischaemic stroke – unprovoked seizure – post-stroke epilepsy

Sources

1. Huang CW, Saposnik G, Fang J et al. Influence of seizures on stroke outcomes: a large multicenter study. Neurology 2014; 82 (9): 768–776. doi: 10.1212/WNL.000000 0000000166.

2. Yang H, Rajah G, Guo A et al. Pathogenesis of epileptic seizures and epilepsy after stroke. Neurol Res 2018; 40 (6): 426–432. doi: 10.1080/01616412.2018.1455014.

3. Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1993; 34 (3): 453–458. doi: 10.1111/j.1528-1157.1993.tb02586.x.

4. Fisher RS, Acevedo C, Arzimanoglou A et al. ILAE Official Report: a practical clinical definition of epilepsy. Epilepsia 2014; 55 (4): 475–482. doi: 10.1111/epi.12550.

5. Hesdorffer DC, Benn EK, Cascino GD et al. Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure. Epilepsia 2009; 50: 1102–1108. doi: 10.1111/j.1528-1167.2008.01945.x.

6. Beghi E, Carpio A, Forsgren L et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia 2010; 51 (4): 671–675. doi: 10.1111/j.1528-1167.2009.02285.x.

7. Doria JW, Forgacs PB. Incidence, implications, and management of seizures following ischemic and hemorrhagic stroke. Curr Neurol Neurosci Rep 2019; 19 (7): 37. doi: 10.1007/s11910-019-0957-4.

8. Zou S, Wu X, Zhu B et al. The pooled incidence of post-stroke seizure in 102 008 patients. Top Stroke Rehabil 2015; 22 (6): 460–467. doi: 10.1179/1074935715Z.00000000062.

9. Wang JZ, Vyas MV, Saposnik G et al. Incidence and management of seizures after ischemic stroke: systematic review and meta-analysis. Neurology 2017; 89 (12): 1220–1228. doi: 10.1212/WNL.0000000000004407.

10. Bladin CF, Alexandrov AV, Bellavance A et al. Seizures after stroke: a prospective multicenter study. Arch Neurol 2000; 57 (11): 1617–1622. doi: 10.1001/archneur.57.11.1617.

11. Altman K, Shavit-Stein E, Maggio N. Post Strokeseizures and epilepsy: from proteases to maladaptive plasticity. Front Cell Neurosci 2019; 13: 397. doi: 10.3389/fncel.2019.00397.

12. Tanaka T, Ihara M. Post-stroke epilepsy. Neurochem Int 2017; 107: 219–228. doi: 10.1016/j.neuint.2017.02.002.

13. Leone MA, Tonini MC, Bogliun G et al. Risk factors for a first epileptic seizure after stroke: a case control study. J Neurol Sci 2009; 277 (1–2): 138–142. doi: 10.1016/j.jns.2008.11.004.

14. Silverman IE, Restrepo L, Mathews GC. Poststroke seizures. Arch Neurol 2002; 59 (2): 195–201. doi: 10.1001/archneur.59.2.195.

15. De Reuck J, Goethals M, Vonck K et al. Clinical predictors of lateonset seizures and epilepsy in patients with cerebrovascular disease. Eur Neurol 2015; 54 (2): 68–72. doi: 10.1159/000087715.

16. Awada A, Omojola MF, Obeid T. Late epileptic seizures after cerebral infarction. Acta Neurol Scand 1999; 99 (5): 265–268. doi: 10.1111/j.1600-0404.1999.tb00674.x.

17. Conrad J, Pawlowski M, Dogan M et al. Seizures after cerebrovascular events: risk factors and clinical features. Seizure 2013; 22 (4): 275–282. doi: 10.1016/j.seizure.2013.01.014.

18. Graham NS, Crichton S, Koutroumanidis M et al. Incidence and associations of poststroke epilepsy: the prospective south london stroke register. Stroke 2013; 44 (3): 605–611. doi: 10.1161/STROKEAHA.111.000220.

19. Lamy C, Domigo V, Semah F et al. Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology 2003; 60 (3): 400–404. doi: 10.1212/wnl.60.3.400.

20. Cordonnier C, Henon H, Derambure P et al. Influence of pre-existing dementia on the risk of post-stroke epileptic seizures. J Neurol Neurosurg Psychiatry 2005; 76 (12): 1649–1653. doi: 10.1136/jnnp.2005.064535.

21. Yang H, Song Z, Yang GP et al. The ALDH2 rs671 polymorphism affects post-stroke epilepsy susceptibility and plasma 4- HNE levels. PLoS One 2014; 9 (10): 109634. doi: 10.1371/journal.pone.0109634.

22. Strzelczyk A, Haag A, Raupach H et al. Prospective evaluation of a post-stroke epilepsy risk scale. J Neurol 2010; 257 (8): 1322–1326. doi: 10.1007/s00415-010-5520-9.

23. Galovic M, Döhler N, Erdélyi-Canavese B et al. Prediction of late seizures after ischaemic stroke with a novel prognostic model (the SeLECT score): a multivariable prediction model development and validation study. Lancet Neurol 2018; 17 (2): 143–152. doi: 10.1016/S1474-4422 (17) 30404-0.

24. Scheffer IE, Berkovic S, Capovilla G et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58 (4): 512–521. doi: 10.1111/epi.13709.

25. Adams HP, Bendixen BH, Kappelle LJ et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 1993; 24 (1): 35–41. doi: 10.1161/01.str.24.1.35.

26. Brott T, Adams HP Jr, Olinger CP et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20 (7): 864–870. doi: 10.1161/01.str.20.7.864.

27. Hassani M, Cooray G, Sveinsson O et al. Post-stroke epilepsy in an ischemic stroke cohort – incidence and diagnosis. Acta Neurol Scand 2020; 141 (2): 141–147. doi: 10.1111/ane.13174.

28. Jungehulsing GJ, Heuschmann PU, Holtkamp M et al. Incidence and predictors of post-stroke epilepsy. Acta Neurol Scand 2013; 127 (6): 427–430. doi: 10.1111/ane.12070.

29. Pitkanen A, Roivainen R, Lukasiuk K. Development of epilepsy after ischaemic stroke. Lancet Neurol 2016; 15 (2): 185–197. doi: 10.1016/S1474-4422 (15) 00248-3.