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Early seizures after ischemic stroke: focus on thrombolysis
Gergely Feher1, Zsuzsanna Gurdan2, Katalin Gombos3
1Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary.
CNS Spectrums
|March 28, 2019
Summary
Early seizures (ESs) following ischemic stroke (IS) occur in 3.8% of patients, often presenting at stroke onset. Risk factors include cortical involvement and stroke severity, with no specific treatment recommendations currently available.
Area of Science:
- Neurology
- Epileptology
- Stroke Medicine
Background:
- Stroke is a primary cause of epilepsy.
- Seizures post-stroke are classified as early (ESs) or late (LSs).
- Thrombolysis treatment may indicate alternative etiologies beyond ischemic stroke (IS).
Purpose of the Study:
- To systematically review the pathogenesis, prevalence, risk factors, detection, management, and outcomes of ESs in IS.
- To investigate the association between recombinant tissue-type plasminogen activator (rt-PA) and epileptic seizures.
Main Methods:
- Systematic review of 37 studies involving 36,775 participants.
- Analysis of data on ES prevalence, risk factors, seizure types, and diagnostic methods.
Main Results:
- The overall ES rate in IS patients was 3.8%, with geographical variations.
- Key risk factors identified: cortical involvement, stroke severity, hemorrhagic transformation, younger age (<65), large lesions, and atrial fibrillation.
- 61% of ESs were partial, 39% were generalized; Status Epilepticus (SE) occurred in 16.3%.
Conclusions:
- Early seizures are infrequent but significant complications of acute stroke.
- A notable percentage of ESs manifest at stroke onset, necessitating thorough diagnostic evaluation.
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