Association of the Timing and Type of Acute Symptomatic Seizures With Poststroke Epilepsy and Mortality

 ABSOLUTELY FUCKING USELESS! Do the research that prevents post stroke epilepsy! At least leaders would do that! There are NO leaders anywhere in stroke!

We've known of this problem a long time. Provide solutions you blithering idiots!

• 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 (14 posts to December 2016)

Association of the Timing and Type of Acute Symptomatic Seizures With Poststroke Epilepsy and Mortality

Kai Michael Schubert, MD, PhD https://orcid.org/0000-0003-1438-7544, Dominik Zieglgänsberger, MD https://orcid.org/0009-0007-7112-304X, Giulio Bicciato, MD https://orcid.org/0000-0002-2956-0189, Laura Abraira, MD, PhD https://orcid.org/0000-0002-5119-7929, Estevo Santamarina, MD, José Álvarez-Sabín, PhD, Carolina Ferreira-Atuesta, MD, MSc https://orcid.org/0000-0003-0853-7163, … Show All … , and Marian Galovic, MD, PhD https://orcid.org/0000-0002-2307-071X marian.galovic@usz.chAuthor Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.124.050045

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Abstract

BACKGROUND:

Acute symptomatic seizures (ASyS) increase the risk of epilepsy and mortality after a stroke. The impact of the timing and type of ASyS remains unclear.

METHODS:

This multicenter cohort study included data from 9 centers between 2002 and 2018, with a final analysis in February 2024. The study included 4552 adults (2005 female; median age, 73 years) with ischemic stroke and no seizure history. Seizures were classified using International League Against Epilepsy definitions. We examined ASyS occurring within seven days after stroke. The main outcomes were all-cause mortality and epilepsy. Validation of the updated SeLECT score (SeLECT-ASyS) was performed in 3 independent cohorts (Switzerland, Argentina, and Japan) collected between 2012 and 2024, including 74 adults with ASyS.

RESULTS:

The 10-year risk of poststroke epilepsy ranged from 41% to 94%, and mortality from 36% to 100%, depending on ASyS type and timing. ASyS on stroke onset day had a higher epilepsy risk (adjusted hazard ratio [aHR], 2.3 [95% CI, 1.3–4.0]; P=0.003) compared with later ASyS. Status epilepticus had the highest epilepsy risk (aHR, 9.6 [95% CI, 3.5–26.7]; P<0.001), followed by focal to bilateral tonic-clonic seizures (aHR, 3.4 [95% CI, 1.9–6.3]; P<0.001). Mortality was higher in those with ASyS presenting as focal to bilateral tonic-clonic seizures on day 0 (aHR, 2.8 [95% CI, 1.4–5.6]; P=0.004) and status epilepticus (aHR, 14.2 [95% CI, 3.5–58.8]; P<0.001). The updated SeLECT-ASyS model, available as an application, outperformed a previous model in the derivation cohort (concordance statistics, 0.68 versus 0.58; P=0.02) and in the validation cohort (0.70 versus 0.50; P=0.18).

CONCLUSIONS:

ASyS timing and type significantly affect epilepsy and mortality risk after stroke, improving epilepsy prediction and guiding patient counseling.

Graphical Abstract

Stroke is a major cause of epilepsy in older adults, contributing to over half of new-onset epilepsy cases in individuals aged ≥65 years.¹ Poststroke seizures are associated with an increased risk of mortality, poor functional outcomes, disability, and dementia.^2,3

Poststroke seizures are categorized into acute symptomatic seizures (ASyS), occurring within the first 7 days after a stroke, and remote symptomatic seizures (RSyS), which are unprovoked seizures occurring later.⁴ ASyS are considered provoked and do not qualify as epilepsy. In contrast, a single or multiple RSyS following ischemic stroke fulfills the International League Against Epilepsy (ILAE) practical definition of epilepsy due to a heightened, >60% recurrence risk of seizures.⁵

ASyS is a major risk factor for epilepsy and mortality following ischemic stroke.^3,6 Recent research underscores the heterogeneity among ASyS, suggesting certain subtypes confer higher risks than others.⁷ We have shown that ASyS presenting as status epilepticus carries a markedly elevated risk of epilepsy and mortality compared with short ASyS after ischemic stroke.³ However, there remains a knowledge gap about other characteristics of ASyS that may be associated with an increased risk of seizures or unfavorable outcomes.

We hypothesized that the timing and type of a short ASyS influence the risk of poststroke epilepsy (PSE) and mortality. We assessed this hypothesis using data from a large multicenter registry of poststroke seizures. We implemented this knowledge in an updated prognostic model that improves the prediction of epilepsy following ASyS after ischemic stroke.

More useless crapola at the link.