Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy
https://www.medscape.com/viewarticle/886872?src=soc_fb_171012_mscpedt_news_mdscp_mdscp_stroke
KYOTO,
Japan — The rate of seizures or epilepsy after thrombolysis for the
treatment of ischemic stroke is similar to the rates in the decades
before the use of thrombolysis, a retrospective study shows.
"Hemorrhagic transformation and degree of neurological compromise after thrombolysis, but not before, were independently associated with seizures or post-stroke epilepsy," lead author, Marino Bianchin, MD, PhD, Hospital Clínicas de Porto Alegre, Brazil, reported.
In the new analysis, presented at the XXIII World Congress of Neurology (WCN), researchers also reported several factors potentially associated with unfavorable outcome and found that seizures were among them.
Seizures and epilepsy affect a substantial proportion of patients after they have had a stroke. In fact, stroke is the leading cause of diagnosis of new-onset epilepsy in patients older than 65 years, Dr Bianchin said.
To evaluate the risk factors, the researchers performed a
retrospective study of 153 consecutive patients who received
thrombolysis using tissue plasminogen activator (tPA) for the treatment
of acute ischemic stroke between 2005 and 2011. Patients were followed
for at least 2 years after the stroke, and those with epilepsy had at
least two prolonged electroencephalograms.
The cohort consisted of 74 women and 79 men, had a mean age of 67.2 ± 13.1 years, and initial and 3-month National Institutes of Health Stroke Scale (NIHSS) mean scores of 10.95 ± 6.25 and 2.09 ± 3.55, respectively.
General health and metabolic variables as well as stroke-specific ones were evaluated as risk factors, including age, sex, ethnicity, hypertension, diabetes mellitus, hypercholesterolemia, smoking, alcohol use, atrial fibrillation, NIHSS score, stroke cause, vascular territories, stroke severity, hemorrhagic transformation, and outcome of thrombolysis.
Response to treatment was assessed by using the NIHSS and modified Rankin Scale (mRS) 3 months after the stroke. A good outcome was considered to be an mRS score of 0 or 1, and a bad outcome was defined as an mRS score of 2 or greater. Bleeding was defined as any central nervous system bleeding according to radiologic criteria.
Of the 153 patients, 21 (13.7%) had seizures and 15 (9.8%)
had epilepsy. The researchers found that of the variables evaluated,
only hemorrhagic transformation and mRS score of 2 or greater were
significant independent risk factors for seizures or for epilepsy.
There was no significant effect of NIHSS score or glucose on admission, systolic blood pressure at onset, diabetes, or hypercholesterolemia.
Table 1. Independent Risk Factors for Seizures or Epilepsy After Thrombolysis
"Hemorrhagic transformation and degree of neurological compromise after thrombolysis, but not before, were independently associated with seizures or post-stroke epilepsy," lead author, Marino Bianchin, MD, PhD, Hospital Clínicas de Porto Alegre, Brazil, reported.
In the new analysis, presented at the XXIII World Congress of Neurology (WCN), researchers also reported several factors potentially associated with unfavorable outcome and found that seizures were among them.
Seizures and epilepsy affect a substantial proportion of patients after they have had a stroke. In fact, stroke is the leading cause of diagnosis of new-onset epilepsy in patients older than 65 years, Dr Bianchin said.
The cohort consisted of 74 women and 79 men, had a mean age of 67.2 ± 13.1 years, and initial and 3-month National Institutes of Health Stroke Scale (NIHSS) mean scores of 10.95 ± 6.25 and 2.09 ± 3.55, respectively.
General health and metabolic variables as well as stroke-specific ones were evaluated as risk factors, including age, sex, ethnicity, hypertension, diabetes mellitus, hypercholesterolemia, smoking, alcohol use, atrial fibrillation, NIHSS score, stroke cause, vascular territories, stroke severity, hemorrhagic transformation, and outcome of thrombolysis.
Response to treatment was assessed by using the NIHSS and modified Rankin Scale (mRS) 3 months after the stroke. A good outcome was considered to be an mRS score of 0 or 1, and a bad outcome was defined as an mRS score of 2 or greater. Bleeding was defined as any central nervous system bleeding according to radiologic criteria.
There was no significant effect of NIHSS score or glucose on admission, systolic blood pressure at onset, diabetes, or hypercholesterolemia.
Table 1. Independent Risk Factors for Seizures or Epilepsy After Thrombolysis
| Endpoint |
Independent Risk Factors for Seizures |
Independent Risk Factors for Epilepsy |
||
| Adjusted Odds Ratio (95% Confidence Interval) |
P Value |
Adjusted Odds Ratio (95% Confidence Interval) |
P Value |
|
| Hemorrhagic transformation |
3.55 (1.11 - 11.34) |
.033 |
3.26 (1.08 - 9.78) |
.035 |
| MRS score ≥ 2 at 3 mo after stroke |
5.82 (1.45 - 23.42) |
.013 |
3.51 (1.20 - 10.32) |
.022 |
| Age, NIHSS score, and seizure were independent risk factors for unfavorable outcome (mRS score of 2 or greater). Table 2. Independent Risk Factors for Unfavorable Outcome (mRS Score ≥ 2)
|
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