Retrospective Database Characterizes Causes, Types of Post-Stroke Seizures

Author(s):

Refractory seizures were more prevalent in hemorrhagic stroke although seizure-free rates were low overall in patients with post-stroke seizures.

Sidra Saleem, MD

Research using a retrospective epilepsy database revealed that cerebrovascular disease is a common cause of seizures, most notably in the middle cerebral artery (MCA) territory. Among this database, levetiracetam was the most commonly used anti-seizure medication (ASD).¹

The study contained data from 2015 to 2019 and was presented at the 2021 American Academy of Neurology (AAN) Annual Meeting, April 17-22, by Sidra Saleem, MD, resident, University of Toledo. Saleem and colleagues aimed to identify the prevalence of post-stroke seizures (PSS) and role of various ASDs in the management of PSS using a cohort of 2721 patients from the database. Among these patients, cerebrovascular disease was found to be common cause of seizures, occurring in 180 (6.61%) patients, with a mean age of 62.85 years (±18.7) and a median age of seizure onset of 54.44 years (±21.3).

Late-onset seizures were more common, occurring in 89.4% of patients compared to 10.55% of those with early-onset seizures. The types of stroke varied, with 77.22% of patients experiencing ischemic stroke, 18.88% with hemorrhagic stroke, and 3.33% reporting ischemic with hemorrhagic transformation.

MCA was the most common arterial territory involved, accounting for 78% of strokes, followed by 16% in the anterior cerebral artery (ACA) territory and 11% in the posterior cerebral artery (PCA) territory.

Levetiracetam, the most commonly prescribed ASD, was used as monotherapy vs polytherapy in 35% vs 23.88% of patients, respectively, with a mean dose of 1500 mg/day (500-4000 mg). Lamotrigine was the second most prescribed ASD, used as monotherapy vs polytherapy in 7.77% vs 8.33% of cases with a mean dose of 279 mg/day (100-800 mg)

Phenytoin was found to be used in 6.11% of cases as a monotherapy and 7.22% as a polytherapy with a mean dose of 500 mg/day (300-900 mg). Lacosamide was the least used ASD, accounting for 3.88% of patients as a monotherapy and 12.22% of patients as a polytherapy with a mean dose of 342 mg/day (100-400 mg). Refractory seizures, which accounted for 46.11%, were more prevalent in patients with hemorrhagic (70.5%) than ischemic stroke (42.4%; P = .0039).

According to the American Stroke Association (ASA), stroke is the most common cause of seizures in older people, with acute onset seizures normally happening within 24 hours of the stroke. Patients are more likely to have a seizure if they’ve suffered a severe stroke, a stroke caused by bleeding in the brain, or a stroke in the cerebral cortex.²

Data presented at the 2020 ASA International Stroke Conference found that post-stroke seizures may be linked to a higher risk of death or disability. Researchers analyzed medical records of 1246 hospital patients without epilepsy upon admission treated for acute ischemic stroke in 59 centers.³

After 12 months, researchers found that 8% of stroke survivors suffered acute seizures within a week of their stroke, and almost 5% of these patients had at least 1 more seizure during the 12-month follow-up period. Patients with severe brain injury and those who had second stroke were also more than 2 times as likely to develop seizures.

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REFERENCES:

1. Saleem S, Sheikh A, Begezda AO, et al. Role of anti-seizure drugs in the treatment of post-stroke seizures: results analysis from retrospective epilepsy database. Presented at 2021 American Academy of Neurology Annual Meeting; April 17-22. Abstract P7.086

2. Controlling Post Stroke Seizures. American Stroke Association. https://www.stroke.org/en/about-stroke/effects-of-stroke/physical-effects-of-stroke/physical-impact/controlling-post-stroke-seizures. Updated December 10, 2018. Accessed April 21, 2021.

3. Developing seizures after stroke may increase risk of death, disability. News release. American Stroke Association. February 12, 2020. Accessed April 21, 2021. https://newsroom.heart.org/news/developing-seizures-after-stroke-may-increase-risk-of-death-disability