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Prospective evaluation of a post-stroke epilepsy risk scale

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Abstract

Ischemic and hemorrhagic strokes are established etiological factors for recurrent seizures. Still, only few prospective data are available to predict post-stroke epilepsy and to choose the best point in time and anticonvulsive agent for treatment. In a prospective study we evaluated 264 consecutive stroke patients and assessed their post-stroke epilepsy risk within a follow-up of 1 year. Data on ten risk items concerning the stroke localisation, persisting neurological deficit, stroke subtype, established diagnosis of vascular encephalopathy, early- and late-onset seizures were collected using a post-stroke epilepsy risk scale (PoSERS). All patients underwent brain imaging with either CT, MRI or both and 148 patients underwent electroencephalography. The overall frequency of early-onset seizures within 14 days was 4.5%, of at least one late seizure 6.4% and of epilepsy 3.8%. Chi-Square tests showed significantly higher relative frequencies of seven of the ten clinical characteristics in post-stroke epilepsy patients. The total scale showed moderate sensitivity (70%) and positive predictive value (87.5%) while specificity (99.6%) and negative predictive value (98.8%) were relatively high. The EEG showed little value in predicting post-stroke epilepsy. The PoSERS appears to be a valuable tool to predict the risk for post-stroke epilepsy within the first few days after a stroke.

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References

  1. Guidelines for epidemiologic studies on epilepsy (1993) Commission on epidemiology and prognosis, International League Against Epilepsy. Epilepsia 34:592–596

    Google Scholar 

  2. Banks JL, Marotta CA (2007) Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 38:1091–1096

    Article  PubMed  Google Scholar 

  3. Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Cote R, Lebrun L, Pirisi A, Norris JW (2000) Seizures after stroke: a prospective multicenter study. Arch Neurol 57:1617–1622

    Article  CAS  PubMed  Google Scholar 

  4. Brodie MJ, Kwan P (2005) Epilepsy in elderly people. BMJ (Clinical research ed) 331:1317–1322

    Article  Google Scholar 

  5. Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C (1997) Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. BMJ (Clinical research ed) 315:1582–1587

    CAS  Google Scholar 

  6. Camilo O, Goldstein LB (2004) Seizures and epilepsy after ischemic stroke. Stroke 35:1769–1775

    Article  PubMed  Google Scholar 

  7. Carrera E, Michel P, Despland PA, Maeder-Ingvar M, Ruffieux C, Debatisse D, Ghika J, Devuyst G, Bogousslavsky J (2006) Continuous assessment of electrical epileptic activity in acute stroke. Neurology 67:99–104

    Article  CAS  PubMed  Google Scholar 

  8. Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J Jr (2005) Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46:470–472

    Article  PubMed  Google Scholar 

  9. Forsgren L, Bucht G, Eriksson S, Bergmark L (1996) Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia 37:224–229

    Article  CAS  PubMed  Google Scholar 

  10. Goldstein LB (1995) Common drugs may influence motor recovery after stroke. The sygen in acute stroke study investigators. Neurology 45:865–871

    CAS  PubMed  Google Scholar 

  11. Hamer HM (2009) Seizures and epilepsies after stroke. Der Nervenarzt 80:405–414

    Article  CAS  PubMed  Google Scholar 

  12. Hauser WA, Annegers JF, Kurland LT (1993) Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 34:453–468

    Article  CAS  PubMed  Google Scholar 

  13. Olsen TS, Hogenhaven H, Thage O (1987) Epilepsy after stroke. Neurology 37:1209–1211

    CAS  PubMed  Google Scholar 

  14. Pugh MJ, Foreman PJ, Berlowitz DR (2006) Prescribing antiepileptics for the elderly: differences between guideline recommendations and clinical practice. Drugs Aging 23:861–875

    Article  PubMed  Google Scholar 

  15. Ryvlin P, Montavont A, Nighoghossian N (2006) Optimizing therapy of seizures in stroke patients. Neurology 67:S3–S9

    PubMed  Google Scholar 

  16. Silverman IE, Restrepo L, Mathews GC (2002) Poststroke seizures. Arch Neurol 59:195–201

    Article  PubMed  Google Scholar 

  17. Strzelczyk A, Reese JP, Dodel R, Hamer HM (2008) Cost of epilepsy: a systematic review. PharmacoEconomics 26:463–476

    Article  PubMed  Google Scholar 

  18. Szaflarski JP, Rackley AY, Kleindorfer DO, Khoury J, Woo D, Miller R, Alwell K, Broderick JP, Kissela BM (2008) Incidence of seizures in the acute phase of stroke: a population-based study. Epilepsia 49:974–981

    Article  PubMed  Google Scholar 

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Acknowledgments

We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. We are grateful to our colleagues and hospital staff for assistance in conducting the study.

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None of the authors has any conflict of interest to disclose.

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Correspondence to Adam Strzelczyk.

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The authors acknowledge that they all agree with the submitted version of the manuscript and that the work is not simultaneously under consideration by any other journal.

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Strzelczyk, A., Haag, A., Raupach, H. et al. Prospective evaluation of a post-stroke epilepsy risk scale. J Neurol 257, 1322–1326 (2010). https://doi.org/10.1007/s00415-010-5520-9

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  • DOI: https://doi.org/10.1007/s00415-010-5520-9

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