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High Risk of Seizures and Epilepsy after Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke
Rosane Brondani1,2,3, Andrea Garcia de Almeida1,2,3, Pedro Abrahim Cherubini2,3
1Postgraduate Program in Medicine: Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Insights
Decompressive hemicraniectomy for malignant stroke leads to high rates of post-stroke epilepsy. Large stroke volume and cortical ischemia are key risk factors for seizures after this procedure.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Decompressive hemicraniectomy (DHC) is a critical intervention for malignant middle cerebral artery (MCA) strokes.
- Post-stroke epilepsy presents a significant challenge for patients undergoing DHC, with limited data on its incidence and risk factors.
Purpose of the Study:
- To determine the prevalence of post-stroke seizures and epilepsy following DHC for malignant MCA strokes.
- To identify risk factors associated with seizure and epilepsy development in this patient cohort.
Main Methods:
- Retrospective cohort study of 36 patients undergoing DHC for malignant MCA strokes.
- Analysis of various factors including age, sex, vascular risk factors, stroke characteristics, and clinical scores for association with seizures/epilepsy.
Main Results:
- High incidence of seizures (61.1%) and epilepsy (55.9%) observed in the cohort.
- Seizures occurred early, with 36.1% developing within the first week.
- No significant association found between seizures/epilepsy and demographic or clinical factors, except for stroke volume and ischemic area.
Conclusions:
- Malignant MCA infarcts treated with DHC have a high risk of developing seizures and epilepsy.
- Early seizure occurrence suggests potential benefit from anticonvulsant prophylaxis.
- Large stroke volume and cortical ischemia are identified as primary risk factors for post-stroke seizures and epilepsy.
Background:
Decompressive hemicraniectomy (DHC) is a life-saving procedure for treatment of large malignant middle cerebral artery (MCA) strokes. Post-stroke epilepsy is an additional burden for these patients, but its incidence and the risk factors for its development have been poorly investigated.
Objective:
To report the prevalence and risk factors for post-stroke seizures and post-stroke epilepsy after DHC for treatment of large malignant MCA strokes in a cohort of 36 patients.
Methods:
In a retrospective cohort study of 36 patients we report the timing and incidence of post-stroke epilepsy. We analyzed if age, sex, vascular risk factors, side of ischemia, reperfusion therapy, stroke etiology, extension of stroke, hemorrhagic transformation, ECASS scores, National Institutes of Health Stroke Scale (NIHSS) scores, or modified Rankin scores were risk factors for seizure or epilepsy after DHC for treatment of large MCA strokes.
Results:
The mean patient follow-up time was 1,086 days (SD = 1,172). Out of 36 patients, 9 (25.0%) died before being discharged. After 1 year, a total of 11 patients (30.6%) had died, but 22 (61.1%) of them had a modified Rankin score ≤4. Thirteen patients (36.1%) developed seizures within the first week after stroke. Seizures occurred in 22 (61.1%) of 36 patients (95% CI = 45.17-77.03%). Out of 34 patients who survived the acute period, 19 (55.9%) developed epilepsy after MCA infarcts and DHC (95% CI = 39.21-72.59%). In this study, no significant differences were observed between the patients who developed seizures or epilepsy and those who remained free of seizures or epilepsy regarding age, sex, side of stroke, presence of the clinical risk factors studied, hemorrhagic transformation, time of craniectomy, and Rankin score after 1 year of stroke.
Conclusion:
The incidence of seizures and epilepsy after malignant MCA infarcts submitted to DHC might be very high. Seizure might occur precociously in patients who are not submitted to anticonvulsant prophylaxis. The large stroke volume and the large cortical ischemic area seem to be the main risk factors for seizure or epilepsy development in this subtype of stroke. .