Why the hell are you blithering idiots predicting seizures rather than preventing them from happening?
Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'.
Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true.
Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.
Predictive Factors of Acute Symptomatic Seizures in Patients With Ischemic Stroke Due to Large Vessel Occlusion
Lisa Marie Tako1,2, 
Adam Strzelczyk1,2*, 
Felix Rosenow1,2, 
Waltraud Pfeilschifter3, Helmuth Steinmetz1, Rejane Golbach4, 
Jan Hendrik Schäfer1, 
Johann Philipp Zöllner1,2 and 
Konstantin Kohlhase1- 1Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- 2LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
- 3Department of Neurology and Neurophysiology, Lüneburg Hospital, Lüneburg, Germany
- 4Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
Introduction: Acute symptomatic seizures (ASz) after ischemic stroke are associated with increased mortality; therefore, identifying predictors of ASz is important. The purpose of this study was to analyze predictors of ASz in a population of patients with ischemic stroke due to large arterial vessel occlusion (LVO).
Materials and Methods: This retrospective study examined patients with acute ischemic stroke caused by LVO between 2016 and 2020. Identification of predictive factors was performed using univariate and subsequent multiple logistic regression analysis. In addition, subgroup analysis regarding seizure semiology and time of seizure occurrence (≤ 24 h and > 24 h after stroke) was performed.
Results: The frequency of ASz among 979 patients was 3.9 % (n = 38). Univariate logistic regression analysis revealed an increased risk of ASz in patients with higher National Institutes of Health Stroke Scale (NIHSS) score at admission or 24 h after admission, hypernatremia at admission ≥ 145 mmol/L, and pneumonia. Further multiple logistic regression analysis revealed that NIHSS 24 h after admission was the strongest predictor of ASz, particularly relating to ASz occurring later than 24 h after stroke. Patients who experienced a seizure within the first 24 h after stroke were more likely to have a generalized tonic-clonic (GTCS) and focal motor seizure; beyond 24 h, seizures with impaired awareness and non-convulsive status epilepticus were more frequent.
Conclusion: NIHSS score 24 h after admission is a strong predictive factor for the occurrence of ASz in patients with ischemic stroke caused by LVO. The semiology of ASz varied over time, with GTCS occurring more frequently in the first 24 h after stroke.
Introduction
Cerebrovascular disease is the most common cause of epilepsy in the elderly, accounting for up to 39–49% of all newly diagnosed epilepsies in patients aged > 60 years (1, 2). Due to demographic changes, the incidence of stroke-related epilepsy is expected to rise and pose an increasing challenge for the healthcare system (3). Depending on the time course, seizures after stroke are defined according to the International League Against Epilepsy (ILAE) either as an acute symptomatic seizure (ASz) if they occur within 7 days, or as an unprovoked late seizure if they occur later than 7 days (4). Acute symptomatic seizures are thought to result from local cellular biochemical dysfunction of electrically excitable tissues, whereas late seizures are caused by post-ischemic remodeling of the damaged brain tissue and neuronal network, leading to an acquired predisposition to seizures and the diagnosis of post-stroke epilepsy (5–8). A large systemic review and meta-analysis examined the frequency of seizures after ischemic stroke; the frequency of ASz was found to be 3.3% and the late post-stroke seizure frequency was 1.8% (9). Because ASz are associated with an increased risk of mortality, knowledge of predictive factors is essential (10, 11). Various risk factors with different levels of evidence are described in the literature. The severity of stroke, estimated by the National Institutes of Health Stroke Scale (NIHSS), and cortical involvement were identified as independent risk factors for the occurrence of ASz (11–16). Data are inconclusive regarding other possible risk factors, such as cardioembolic infarct etiology, anterior circulation cerebral infarction, hemorrhagic transformation, previous transient ischemic attack (TIA), acute non-neurological infection, and history of diabetes mellitus (10, 11, 13, 17). Based on these results, different prediction models have been developed to assess the individual risk for post-stroke seizures (18, 19). Furthermore, therapy with statins in the acute phase of stroke was reported to reduce the rate of seizures (20). Systemic thrombolysis and mechanical thrombectomy as established reperfusion procedures have also been the subject of research, with recent studies showing no association with ASz frequency (21, 22).
The variability among identified predictive factors may be explained by the heterogeneous designs of the available studies, with varying levels of evidence (registry studies, retrospective and prospective designs, mono- or multi-centric studies, systematic reviews), inclusion criteria (hemorrhagic and ischemic stroke), and definitions of ASz occurring later than 7 days (17, 23, 24). Furthermore, the studies were conducted over an extended period, including several studies in which neurological treatment in stroke units differed and new therapeutic milestones, such as mechanical recanalization, had not yet been established.
The purpose of this study is to analyze predictive factors for ASz in a well-defined patient population who experienced an ischemic stroke due to large vessel occlusion (LVO) and who were treated after mechanical recanalization had become the standard therapy for LVO in 2016.
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