Stroke-related epilepsy in the rehabilitation setting: Insights from the inpatient post-stroke rehabilitation study – RIPS

 Precisely why was this research done? Incompetence of the mentors and senior researchers not knowing previous research? That's being polite!

Look how long we've known of the problem.

• 10% seizures post stroke (19 posts to April 2017)

• 5% epileptic seizures after stroke (10 posts to April 2021)

• epileptic seizures (6 posts to December 2015)

• post-stroke epilepsy (7 posts to December 2016)

Just maybe you want your doctor to try these solutions.

Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy

Or maybe the nasal spray referred to in here:

Preventing Seizure-Caused Damage to the Brain

The answers are out there, does your doctor know about them? 

Mozart may reduce seizure frequency in people with epilepsy

 

A dietary supplement dampens the brain hyperexcitability seen in seizures or epilepsy

 The latest here:

Stroke-related epilepsy in the rehabilitation setting: Insights from the inpatient post-stroke rehabilitation study – RIPS

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https://doi.org/10.1016/j.ebr.2024.100713

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Highlights

• •
  In stroke survivors, persistent seizure activity could be associated with poor functional outcomes.
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  Over-treatment could hamper post-stroke recovery.
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  We analyzed EEG and anti-seizure medication management on 163 post-stroke patients.
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  Multi-centre prospective study involving two intensive rehabilitation units (IRUs).

Abstract

Objective

In stroke survivors, persistent seizure activity could be associated with poor functional outcomes. At the same time, antiepileptic over-treatment could hamper post-stroke recovery. We systematically investigated the occurrence of seizures, the prevalence of epileptic discharges, and delta slow waves on electroencephalogram (EEG) and anti-seizure medication (ASM) management in relation to clinical manifestations and EEG abnormalities.

Materials and methods

This was a multi-centre prospective study involving two intensive rehabilitation units (IRUs). Clinical and EEG data were acquired at admission to the IRU, discharge (T1), and six-month follow-up (T2).

Results

A total of 163 patients underwent EEG recording upon admission to the IRU, while 149 were available for analysis at discharge from the IRU. Eighteen patients were treated with ASMs upon IRU admission despite only five of these patients having early seizures. Among the 145 patients not treated upon admission to the IRU, eight had late seizures, of which six were during the IRU stay, while two were after discharge from the IRU. During IRU stay, ASMs were generally discontinued in patients with no early seizures reported and were started in patients with late seizures. Among the 18 patients treated with ASMs at admission to the IRU, only six maintained the therapy also at T2.

Conclusion

Our results suggest that post-acute inpatient rehabilitation is a proper setting to observe patients treated with ASMs after stroke and provide personalized post-stroke epilepsy management.

Keywords

ASMs

EEG

Epilepsy

Rehabilitation

Seizures

Stroke

1. Introduction

Stroke-related epilepsy (STRE) [1] ranges from 2 % to 14 % depending on the study population [2], [3] and accounts for nearly 50 % of newly diagnosed epilepsy inpatients over 60 years old. With the increasing prevalence of post-stroke survivors, mainly related to the aging of the population and the improvement of hyperacute stroke care, the number of patients with STRE is expected to increase [4], [5]. Seizures may occur in close temporal association with stroke (acute symptomatic, provoked, or early seizures (ESs), or after a variable interval, from several days to years following the stroke (late seizures, LSs) [6]. While ESs result from local metabolic disturbances, LSs occur in relation to altered neuronal networks, i.e. when the brain acquires a predisposition for seizures. In stroke survivors, persistent seizure activity could hamper post-stroke recovery, cause temporary or even permanent neurological deterioration, and predict poor functional outcomes [7]. Furthermore, seizures affect not only the quality of life of the patient but also that of their families [8]. STRE may occur or recur during post-acute rehabilitation [9]. Therefore, the management of LSs should be considered as part of the individual rehabilitation project, aiming to improve functional outcomes in post-stroke patients with STRE. Specifically, STRE diagnosis and the management of anti-seizure medication (ASM), mainly based on careful evaluation of efficacy combined with the evaluation of side effects and drug-drug interaction, are a necessary intervention to be carried out during the rehabilitation stay [10].

To the best of our knowledge, the incidence of STRE and ASM management in post-acute stroke inpatient rehabilitation, although relevant to aiming to identify any clinical/instrumental indicators for the development of LSs and to improve the management of post-stroke patients in a sub-acute setting, has not been investigated by previous studies. Thus, in the context of a multicentre observational prospective study investigating predictors of functional outcomes at discharge from inpatient post-stroke rehabilitation (RIPS study) [11], we aimed to systematically observe the occurrence of early and late seizures, from admission to the Intensive Rehabilitation Unit (IRU) to discharge and to six-month after the stroke and the relationship between seizure and the prevalence of epileptic discharges, and delta slow waves on the electroencephalogram (EEG) In addition, we aimed to describe and discuss ASM management in relation to clinical manifestations and EEG abnormalities.