Once epilepsy is predicted; WHAT ARE THE EXACT PROTOCOLS THAT WILL PREVENT IT FROM OCCURRING? That is the research needed which won't occur because we have NO stroke leadership at all!
We already knew of epilepsy post stroke; why the fuck aren't you solving the prevention problem?
Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my 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:
Novel Tool Improves Prediction of Epilepsy After Ischemic Stroke
A new clinical and neuroimaging tool that predicts which patients are most likely to develop epilepsy following an ischemic stroke has been developed.
The score is “an updated, validated, and readily applicable tool” that can help clinicians identify patients at high risk of poststroke epilepsy (PSE), the researchers reported. Led by William C.Y. Leung, MBBS, MRCP, of Massachusetts General Hospital (MGH), Harvard Medical School, Boston, and the University of Hong Kong, Pok Fu Lam, Hong Kong, the team said the approach may enable more personalized care and inform future trials of antiepileptogenic therapies after ischemic stroke.
The findings were published online on January 5 in Neurology.
Internationally Validated
Defined as an unprovoked seizure occurring more than 7 days after an acute stroke, PSE is a relatively common complication, affecting about 4% of patients within the first year and 8% within 5 years after stroke.
The authors noted that current tools used to predict PSE have important limitations, including minimal incorporation of neuroimaging features that influence epileptogenesis and development in patient cohorts treated before modern reperfusion therapies became routine.
To address these limitations, the researchers developed and internationally validated a practical, imaging-informed risk score using routinely available clinical and neuroimaging data to better identify patients at a high risk for PSE.
To develop it, the researchers assessed 1436 adults with a first ischemic stroke (mean age, 67.4 years; 54.7% male) from a prospective stroke registry at MGH.
From medical records and neuroimaging scans, they gathered and assessed information on relevant stroke variables, and use of intravenous (IV) thrombolysis or intra-arterial thrombectomy.
They also obtained seizure information, including EEG reports, treatment, date of first seizure, and any status epilepticus, seizure requiring intensive care monitoring, and drug-resistant seizures.
After a median follow-up of 68 months, 5.5% of the study population developed PSE.
Strong PSE Predictor
The final model underlying the proposed score — called IsCHEMiA, derived from the first letters of each variable — includes six factors: infarct size ≥ 5 cm, cortical involvement, any hemorrhagic transformation, early symptomatic seizure within 7 days of stroke, middle cerebral artery involvement, and age younger than 65 years.
Researchers calculated the probability of developing PSE and risk estimates of PSE at 1 and 5 years after a stroke.
Results showed that the IsCHEMiA score was a strong predictor of PSE and demonstrated excellent discrimination, with a c-statistic of 0.87 (with 1.0 indicating perfect discrimination).
The model was validated in two independent international cohorts totaling 2534 patients — two in Hong Kong and one in Japan. The analyses showed discrimination similar to that seen in the US cohort, with c-statistics of 0.852 and 0.857 in the Hong Kong cohorts and 0.826 in the Japanese cohort.
The validation suggests that the IsCHEMiA score may be applicable worldwide, independent of ethnic differences in stroke, including variations in etiology, lifestyle, and diet, the authors noted.
Using the tool, a score of 3 corresponds to a low risk for PSE — about 2% at 1 year and 6% at 5 years — whereas a score of 8 or higher predicts a high risk, with seizure rates of 67% at 1 year and 78% at 5 years after stroke.
The findings also suggest that antiseizure medications may be appropriate for patients who experience a single early seizure and have an IsCHEMiA score of 8 or higher, the authors noted.
New and Improved Tool
Overall, the IsCHEMiA score outperformed previous prediction tools by incorporating infarct size and hemorrhagic transformation, two key imaging features not included in earlier models.
Younger age was another newly identified risk factor included in the score. The authors suggest this may reflect greater neuroplasticity and neuroinflammatory responses in younger adults, as well as increased vigilance and awareness for seizures.
A key strength of the study is that the predictors used in IsCHEMiA are objectively measured, clearly defined, and routinely available in clinical practice, making the score “a practical tool that is easily applicable in daily clinical practice,” the authors wrote.
In addition to strengths, the investigators noted several limitations, including potential variations in stroke management across international cohorts and differences in the detection of hemorrhagic transformation related to imaging availability, sequences, and timing.
In addition, the effects of revascularization therapies on PSE were not well assessed because of small sample sizes, and follow-up in the validation cohorts was shorter than in the US derivation cohort.
Recall bias may also have influenced the findings because some patients may not recognize subtle or nonmotor seizure symptoms, while those with cognitive or language impairments may be unable to report seizure-related events.
The authors outlined several potential clinical uses for the IsCHEMiA score. In addition to identifying stroke patients at a high risk for PSE, the tool could prompt EEG screening and closer monitoring, help guide decisions about antiseizure medication use, and support future research into the added predictive value of serum biomarkers, EEG patterns, and advanced imaging techniques.
Appealing Features
In an accompanying editorial, Joseph Kamtchum Tatuene of the Wolfson Centre for Prevention of Stroke and Dementia at the University of Oxford, Oxford, England, and Alain Lekoubou of the Penn State College of Medicine, Hershey, Pennsylvania, wrote that several features of the new score are “appealing.”
They cited its ease of use, lack of reliance on EEG findings, and incorporation of objective neuroimaging measures such as infarct size and hemorrhagic transformation.
The editorial noted that including hemorrhagic transformation in the IsCHEMiA score is particularly relevant as revascularization therapies become more widely used. The authors emphasized that this highlights the need for closer monitoring for hemorrhagic transformation and more aggressive management of modifiable risk factors, especially elevated blood pressure and hyperglycemia before IV thrombolysis.
They also cautioned that the score does not account for several pre- or poststroke factors that may influence brain health and seizure susceptibility, including family history of epilepsy and genetic risk.
In addition, although the IsCHEMiA score was derived in a North American cohort and validated in Asian populations, its performance relative to other prediction tools in European or African populations remains uncertain.
The editorialists added that other potential determinants of PSE — such as prior seizures, psychiatric illness, traumatic brain injury, meningitis, chronic alcohol exposure, medical comorbidities, and environmental factors — were not included and warrant further study.
However, they noted the score doesn’t consider some important pre- or poststroke determinants of brain health and susceptibility to seizures such as a family history of epilepsy and a high polygenic risk score for epilepsy that significantly increases the risk for PSE.
While the IsCHEMiA score was derived in a North American population and validated in Asian populations, it’s not clear if it would outperform other predictive scores in European or African populations, said the editorial writers.
Several factors still need to be considered, they added. These include history of seizures (provoked or not), psychiatric disorders, meningitis, traumatic brain injury, chronic exposure to alcohol consumption, perinatal adverse events, medical comorbidities, and environmental exposures to, for example, noise and pollution.
The authors and editorialists reported having no relevant financial disclosures.
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