Clinical Methods Supporting Initial Recognition of Early Post-Stroke Seizures: A Systematic Scoping Review

Area of Science:

• Neurology
• Clinical Medicine
• Seizure Disorders

Background:

• Stroke is a primary cause of seizures and epilepsy, increasing mortality and disability.
• Timely seizure recognition and management in acute stroke patients are critical for better outcomes.
• Current post-stroke seizure monitoring often relies on clinical suspicion, underscoring the need for effective bedside methods.

Purpose of the Study:

• To map the existing literature on clinical methods for bedside identification and monitoring of early post-stroke seizures (EPSSs).

Main Methods:

• A scoping review of literature concerning adults with acute ischemic stroke or intracerebral hemorrhage and suspected inpatient EPSS.
• Searches conducted across major databases (Medline, CINAHL, Embase, Cochrane Library) for English-language publications up to April 2023.
• Inclusion of diverse sources: primary research, case reports, reviews, guidelines, and expert opinions, with reference list reviews.

Main Results:

• Thirty papers met inclusion criteria, comprising research studies, expert opinions, case reports, and clinical guidelines.
• Empirical evidence supporting clinical methods for seizure recognition and monitoring in acute stroke was found to be limited.
• No studies assessed the comparative effectiveness of different seizure detection approaches, and existing recommendations lacked consensus and detail.

Conclusions:

• Accurate diagnosis of EPSS is crucial due to its significant impact on patient outcomes.
• The review identified inconsistencies in current monitoring practices for post-stroke seizures.
• There is a clear and urgent need for targeted research to develop and validate effective clinical strategies for identifying EPSS in acute stroke care.