The epıdemıology of post-stroke epılepsy accordıng to stroke subtypes Authors: Benbir, G.; Ince, B.; Bozluolcay, M.
Source: Acta Neurologica Scandinavica, Volume 114, Number 1, July 2006, pp. 8-12(5)
Abstract:
Strokes represent the most common etiology of epilepsy in patients over the age of 60 years, with an incidence of 2-4% occurring in different studies. Materials and Methods:
In this observational study, 1,428 patients were included who had stroke and were admitted to our Stroke Unit between the years 1996 and 2005.
Results:
Overall, 51 patients had post-stroke epilepsy (3.6%). Post-ischemic epilepsy occurred in 70.6% of the patients, post-hemorrhagic epilepsy occurred in 21.6% of the patients and epilepsy following venous infarctions occurred in 7.8% of all post-stroke epilepsy patients. Of 1,327 patients having ischemic stroke, 36 patients (2.7%), 11 out of 86 patients with hemorrhagic stroke (12.8%) and 4 of 15 patients with venous infarctions (26.6%) developed epilepsy. Compared with stroke patients without epilepsy, hemorrhagic (P < 0.001) and venous infarctions were more common in patients with post-stroke epilepsy (P < 0.001). The right hemisphere and the middle cerebral artery (MCA) territory were most commonly observed in ischemic and hemorrhagic stroke patients.
Conclusions:
Our results indicate that post-stroke epilepsy is more common among patients who have experienced venous infarctions. Hemorrhagic and venous infarctions are more commonly encountered in post-stroke epilepsy patients. Atherosclerotic and cardioembolic strokes were similar to those that occurred in post-stroke epilepsy patients. Localizations in post-stroke epileptic patients showed that the majority occurred in the right hemisphere, in the territory of the MCA. However, prospective, multicentered studies are needed for a better understanding of the epidemiology and social impact of post-stroke epilepsy.
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(Stroke. 2004;35:1769.)
© 2004 American Heart Association, Inc.
Seizures and Epilepsy After Ischemic Stroke
Osvaldo Camilo, MD Larry B. Goldstein, MD
From the Department of Medicine (Neurology) (O.C., L.B.G.), the Duke Center for Cerebrovascular Disease (O.C., L.B.G.), and the Stroke Policy Program (O.C.), Center for Clinical Health Policy Research, Duke University, Durham, NC; and the Durham VA Medical Center (O.C.), Durham, NC.
Correspondence to Dr Larry B. Goldstein, Director, Duke Center for Cerebrovascular Disease, Head, Stroke Policy Program, Center for Clinical Health Policy Research Box 3651, Duke University Medical Center Durham, NC 27710. E-mail [Ссылки доступны только зарегистрированным пользователям ]
Background— Although a long-recognized clinical phenomenon, there remain many questions regarding the epidemiology of seizures and epilepsy after ischemic stroke, their effect on outcome, and their treatment.
Summary of Review— Interpretation of the various studies that have been conducted of postischemic stroke seizures and epilepsy are complicated by their heterogeneous designs, inconsistent uses of terminology, small sample sizes, different periods of follow-up, and ambiguities in seizure identification and classification. Estimates of the rate of early postischemic stroke seizures range from 2% to 33%. The rates of late seizures vary from 3% to 67%. The rate of postischemic stroke epilepsy is 2% to 4% and is higher in those who have a late seizure. Data reflecting seizure subtypes are limited. Aside from cortical location and, possibly, stroke severity, no other risk factors for postischemic stroke seizures have been consistently demonstrated. Results regarding the impact of postischemic stroke seizures on outcome are inconsistent.
Conclusions— Much additional work is needed to better understand the epidemiology and social impact of postischemic stroke seizures and epilepsy, their prevention, and optimal management.
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REVIEW
Post-stroke seizure and post-stroke epilepsy
P K Myint1,2,3, E F A Staufenberg2,4 and K Sabanathan1,2
1 Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, UK
2 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
3 Clinical Gerontology Unit and Lewin Stroke Unit, Addenbrooke’s Hospital, Cambridge, UK
4 Norwich Epilepsy Clinic, Little Plumstead Hospital, Little Plumstead, Norwich, UK
Correspondence to:
Dr P K Myint
Clinical Gerontology Unit, Level 2, F&G Block, Box 251, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK; [Ссылки доступны только зарегистрированным пользователям ]
Post-stroke seizure and post-stroke epilepsy are common causes of hospital admissions, either as a presenting feature or as a complication after a stroke. They require appropriate management and support in long term. With an increasingly ageing population, and age itself being an independent risk factor for stroke, the incidence and prevalence of post-stroke seizure and post-stroke epilepsy is likely to increase. This article examines aetiology, clinical presentation, and presents a management outline of these conditions with particular focus on adults. The aim of this review article is to provide the clinicians with background information and recommendations.
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NEUROLOGY 2006;67:2048-2049
© 2006 American Academy of Neurology
Brief Communications
Seizures during stroke thrombolysis heralding dramatic neurologic recovery
L. H. Rodan, BSc, R. I. Aviv, MRCP, FRCR, D. J. Sahlas, MSc, MD, FRCPC, B. J. Murray, MD, FRCPC, J. P. Gladstone, MD, FRCPC and D. J. Gladstone, MD, FRCPC, PhD
From the North and East GTA Regional Stroke Centre, Division of Neurology (Department of Medicine), Division of Neuroradiology, and Neurosciences Program, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada, and the Heart and Stroke Foundation Centre for Stroke Recovery.
Address correspondence and reprint requests to Dr. David J. Gladstone, Division of Neurology and Regional Stroke Centre, A442, Sunnybrook and Women’s College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5; e-mail: [Ссылки доступны только зарегистрированным пользователям ]
Seizures during thrombolytic therapy for ischemic stroke have not previously been described as a favorable prognostic sign. We report three patients with severe stroke (NIH Stroke Scale [NIHSS] score 15 to 20) who experienced a seizure during tissue plasminogen activator (tPA) infusion. While initially raising alarm about possible hemorrhage, the seizures heralded dramatic recovery (an immediate 15-point NIHSS score improvement after tPA; NIHSS score 0 or 1 at 24 hours). We propose that the seizures during thrombolysis may indicate cortical reperfusion and/or hyperperfusion due to early recanalization of an acutely occluded intracranial artery.
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