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Elschot EP, Joore MA, Rouhl RPW, Lamberts RJ, Backes WH, Jansen JFA. The added value of risk assessment and subsequent targeted treatment for epileptic seizures after stroke: An early-HTA analysis. Epilepsy Behav 2024; 151:109594. [PMID: 38159505 DOI: 10.1016/j.yebeh.2023.109594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The development of post-stroke epilepsy (PSE) is related to a worse clinical outcome in stroke patients. Adding a biomarker to the clinical diagnostic process for the prediction of PSE may help to establish targeted and personalized treatment for high-risk patients, which could lead to improved patient outcomes. We assessed the added value of a risk assessment and subsequent targeted treatment by conducting an early Health Technology Assessment. METHODS Interviews were conducted with four relevant stakeholders in the field of PSE to obtain a realistic view of the current healthcare and their opinions on the potential value of a PSE risk assessment and subsequent targeted treatment. The consequences on quality of life and costs of current care of a hypothetical care pathway with perfect risk assessment were modeled based on information from a literature review and the input from the stakeholders. Subsequently, the maximum added value (the headroom) was calculated. Sensitivity analyses were performed to test the robustness of this result to variation in assumed input parameters, i.e. the accuracy of the risk assessment, the efficacy of anti-seizure medication (ASM), and the probability of patients expected to develop PSE. RESULTS All stakeholders considered the addition of a predictive biomarker for the risk assessment of PSE to be of value. The headroom amounted to €12,983. The sensitivity analyses demonstrated that the headroom remained beneficial when varying the accuracy of the risk assessment, the ASM efficacy, and the number of patients expected to develop PSE. DISCUSSION We showed that a risk assessment for PSE development is potentially valuable. This work demonstrates that it is worthwhile to undertake clinical studies to evaluate biomarkers for the prediction of patients at high risk for PSE and to assess the value of targeted prophylactic treatment.
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Affiliation(s)
- Elles P Elschot
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands
| | - Manuela A Joore
- CAPHRI Care and Public Health Research Institute, Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands
| | - Rob P W Rouhl
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands
| | - Rob J Lamberts
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, De Rondom 70, Eindhoven, the Netherlands.
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Zaccara G, Lattanzi S, Brigo F. Acute symptomatic seizures after stroke: A scoping review on primary prevention, treatment with antiseizure medications and drug discontinuation. Epilepsy Behav 2023; 149:109499. [PMID: 37972420 DOI: 10.1016/j.yebeh.2023.109499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
AIM To evaluate and synthesize the evidence and knowledge gaps on primary prevention and treatment of post-stroke acute symptomatic seizures (ASSs) using antiseizure medications (ASMs). METHODS We systematically searched of EMBASE, MEDLINE (accessed from PubMed), and the Cochrane Central Register of Controlled Trials (CENTRAL) to include randomized, double- or single-blinded trials (RCTs) on primary prophylaxis and treatment of post-stroke ASSs with ASMs. The risk of bias in the included studies was assessed according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Two placebo-controlled RCTs (totaling 114 participants) evaluating valproate or levetiracetam as primary prophylaxis of ASSs due to hemorrhagic stroke were included. In one RCT, post-stroke ASS occurred in 1/36 patients (2.7%) on valproate and in 4/36 patients (7%) on placebo (p = 0.4). In the other RCT, ASSs were only electrographic and occurred in 3/19 (16%) with levetiracetam and in 10/23 (43%) with placebo (p = 0.043). We found no RCTs on the treatment of post-stroke ASSs or discontinuation of ASMs administered for the treatment of post-stroke ASSs. CONCLUSION Evidence to support primary prophylaxis of ASSs is sparse and of very low quality and is insufficient to recommend it routinely. Secondary prevention of post-stroke ASSs is usually not recommended except in selected cases (the most relevant being acute symptomatic status epilepticus, which carries a high risk of subsequent poststroke seizures (PSE)). The choice of which ASM to administer and for how long is not based on solid RCT evidence. Management of post-stroke PSE should be done according to an evidence-based framework, considering the individuality of the patient and the pharmacological properties of the drugs.
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Affiliation(s)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano-Bozen, Italy.
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García-Peña P, Ramos M, López JM, Martinez-Murillo R, de Arcas G, Gonzalez-Nieto D. Preclinical examination of early-onset thalamic-cortical seizures after hemispheric stroke. Epilepsia 2023; 64:2499-2514. [PMID: 37277947 DOI: 10.1111/epi.17675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Ischemic stroke is one of the main causes of death and disability worldwide and currently has limited treatment options. Electroencephalography (EEG) signals are significantly affected in stroke patients during the acute stage. In this study, we preclinically characterized the brain electrical rhythms and seizure activity during the hyperacute and late acute phases in a hemispheric stroke model with no reperfusion. METHODS EEG signals and seizures were studied in a model of hemispheric infarction induced by permanent occlusion of the middle cerebral artery (pMCAO), which mimics the clinical condition of stroke patients with permanent ischemia. Electrical brain activity was also examined using a photothrombotic (PT) stroke model. In the PT model, we induced a similar (PT group-1) or smaller (PT group-2) cortical lesion than in the pMCAO model. For all models, we used a nonconsanguineous mouse strain that mimics human diversity and genetic variation. RESULTS The pMCAO hemispheric stroke model exhibited thalamic-origin nonconvulsive seizures during the hyperacute stage that propagated to the thalamus and cortex. The seizures were also accompanied by progressive slowing of the EEG signal during the acute phase, with elevated delta/theta, delta/alpha, and delta/beta ratios. Cortical seizures were also confirmed in the PT stroke model of similar lesions as in the pMCAO model, but not in the PT model of smaller injuries. SIGNIFICANCE In the clinically relevant pMCAO model, poststroke seizures and EEG abnormalities were inferred from recordings of the contralateral hemisphere (noninfarcted hemisphere), emphasizing the reciprocity of interhemispheric connections and that injuries affecting one hemisphere had consequences for the other. Our results recapitulate many of the EEG signal hallmarks seen in stroke patients, thereby validating this specific mouse model for the examination of the mechanistic aspects of brain function and for the exploration of the reversion or suppression of EEG abnormalities in response to neuroprotective and anti-epileptic therapies.
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Affiliation(s)
- Pablo García-Peña
- Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid, Madrid, Spain
| | - Milagros Ramos
- Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid, Madrid, Spain
- Departamento de Tecnología Fotónica y Bioingeniería, ETSI Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Juan M López
- Instrumentation and Applied Acoustics Research Group (I2A2), Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Guillermo de Arcas
- Instrumentation and Applied Acoustics Research Group (I2A2), Universidad Politécnica de Madrid, Madrid, Spain
- Departamento de Ingeniería Mecánica, ETSI Industriales, Universidad Politécnica de Madrid, Madrid, Spain
- Laboratorio de Neuroacústica, Universidad Politécnica de Madrid, Madrid, Spain
| | - Daniel Gonzalez-Nieto
- Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid, Madrid, Spain
- Departamento de Tecnología Fotónica y Bioingeniería, ETSI Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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Wei X, Huang G, Liu J, Ge J, Zhang W, Mei Z. An update on the role of Hippo signaling pathway in ischemia-associated central nervous system diseases. Biomed Pharmacother 2023; 162:114619. [PMID: 37004330 DOI: 10.1016/j.biopha.2023.114619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
The most frequent reason of morbidity and mortality in the world, cerebral ischemia sets off a chain of molecular and cellular pathologies that associated with some central nervous system (CNS) disorders mainly including ischemic stroke, Alzheimer's disease (AD), Parkinson's disease (PD), epilepsy and other CNS diseases. In recent times, despite significant advancements in the treatment of the pathological processes underlying various neurological illnesses, effective therapeutic approaches that are specifically targeted to minimizing the damage of such diseases remain absent. Hippo signaling pathway, characterized by enzyme linked reactions between MSTI/2, LAST1/2, and YAP or TAZ proteins, controls cell division, survival, and differentiation, as well as being engaged in a variety of biological activities, such as the development and transformation of the nervous system. Recently, accumulating studies demonstrated that Hippo pathway takes part in the processes of ischemic stroke, AD, PD, etc., including but not limited to oxidative stress, inflammatory response, blood-brain barrier damage, mitochondrial disorders, and neural cells death. Thus, it's crucial to understand the molecular basis of the Hippo signaling pathway for determining potential new therapeutic targets against ischemia-associated CNS diseases. Here, we discuss latest advances in the deciphering of the Hippo signaling pathway and highlight the therapeutic potential of targeting the pathway in treating ischemia-associated CNS diseases.
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Kohlhase K, Schäfer JH, Tako LM, Willems LM, Hattingen E, Bohmann FO, Grefkes C, Rosenow F, Strzelczyk A. Large-vessel-occlusion in patients with previous ischemic stroke: an analysis of adherence to secondary preventive medication for different etiologies. Neurol Res Pract 2023; 5:22. [PMID: 37226225 PMCID: PMC10210396 DOI: 10.1186/s42466-023-00247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Large vessel occlusion (LVO) is a severe condition that carries a high risk of morbidity and mortality, underscoring the importance of effective prevention strategies. This retrospective study aimed to analyze the intake of preventive medication at the time of hospitalization in a cohort of recurrent stroke patients presenting with acute LVO. METHODS The study assessed the intake of either platelet aggregation inhibitors (PAI), oral anticoagulants (OAC) or statins at admission in patients with recurrent stroke and correlated it with the final classification of LVO. The frequency of those secondary preventive medication in recurrent stroke patients was defined as primary endpoint. The Modified Rankin Scale (mRS) at discharge was used as a functional outcome and defined as a secondary outcome measure. RESULTS This study included 866 patients who were treated for LVO between 2016 and 2020, of whom 160 (18.5%) had a recurrent ischemic stroke. OAC (25.6% vs. 14.1%, p < 0.01), PAI (50.0% vs. 26.0%, p < 0.01), or statin therapy (50.6% vs. 20.8%, p < 0.01) at admission were significantly more frequent in recurrent stroke patients compared to patients with a first-time stroke. Concerning LVO etiology in recurrent stroke patients, OAC at admission was taken in 46.8% of cardioembolic LVO, whereas PAI and statin at admission in macroangiopathic LVO were administered to 40.0%; neither PAI nor OAC was taken in 26.0%, 28.3%, and 31.6% of cardioembolic, macroangiopathic, or cryptogenic strokes, respectively. Regardless of stroke recurrence or etiology, there was an increase in mRS at discharge. CONCLUSIONS Despite high-quality healthcare, this study suggested a significant proportion of patients with recurrent stroke who were either non-adherent or insufficiently adherent to secondary preventive medication. Given the disability associated with LVO, improving patients' medication adherence and identifying unknown stroke causes are crucial for effective prevention strategies.
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Affiliation(s)
- Konstantin Kohlhase
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Jan Hendrik Schäfer
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Lisa Marie Tako
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Laurent M Willems
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ferdinand O Bohmann
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christian Grefkes
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
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Winder K, Bobinger T, Seifert F, Mrochen A, Haupenthal D, Knott M, Dörfler A, Hilz MJ, Schwab S, Fröhlich K. Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy. J Neuroimaging 2023. [PMID: 37129978 DOI: 10.1111/jon.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND AND PURPOSE The relationship between ischemic stroke site and occurrence of poststroke epilepsy (PSE) is incompletely understood. This study intended to evaluate incidence and temporal profiles of seizures and to correlate ischemic lesion sites with PSE using voxel-based lesion symptom mapping (VLSM). METHODS Patients with imaging-confirmed first-ever ischemic stroke without prior history of epilepsy were prospectively included. Demographic data, cardiovascular risk factors, and National Institute of Health Stroke Scale (NIHSS) scores were assessed. Data on seizures and modified Rankin scale scores were determined within a 90-day period after stroke onset. Ischemic lesion sites were correlated voxel wise with occurrence of PSE using nonparametric permutation test. Age- and sex-matched patients with first-ever ischemic strokes without PSE after 90 days served as controls for the VLSM analysis. RESULTS The stroke database contained 809 patients (mean age: 68.4 ± 14.2 years) with first-ever imaging-confirmed ischemic strokes without history of epilep. Incidence of PSE after 90-day follow-up was 2.8%. Five additional patients were admitted to the emergency department with a seizure after 90-day follow-up. Fifty percent of the seizures occurred in the acute phase after stroke. PSE patients had higher NIHSS scores and infarct volumes compared to controls without PSE (p < .05). PSE patients had infarcts predominantly involving the cerebral cortex. The hemisphere-specific VLSM analysis shows associations between PSE and damaged voxels in the left-hemispheric temporo-occipital transition zone. CONCLUSIONS The data indicate that PSE occurs in a small proportion of patients with rather large ischemic strokes predominantly involving the cerebral cortex. Especially patients with ischemic lesions in the temporo-occipital cortex are vulnerable to develop PSE.
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Affiliation(s)
- Klemens Winder
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
- Department of Neurology and Stroke Center, Klinik Hirslanden, Zürich, Switzerland
| | - Tobias Bobinger
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Frank Seifert
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Anne Mrochen
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - David Haupenthal
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Michael Knott
- Department of Neuroradiology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Max J Hilz
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Kilian Fröhlich
- Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
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Punia V, Li Y, Lapin B, Chandan P, Newey C, Hantus S, Dhakar M, Rubinos C, Zafar S, Sivaraju A, Katzan IL. Impact of acute symptomatic seizures and their management on patient-reported outcomes after stroke. Epilepsy Behav 2023; 140:109115. [PMID: 36804847 DOI: 10.1016/j.yebeh.2023.109115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Acute symptomatic seizures (ASyS) after stroke are not uncommon. However, the impact of ASyS and its management with anti-seizure medications (ASMs) on patient-reported outcome measures (PROMs) remains poorly investigated. The objective of our study is to evaluate the association between PROMs and ASyS and ASMs following stroke. METHODS We performed a retrospective cohort study of all stroke patients who underwent inpatient continuous EEG (cEEG) monitoring performed due to suspected ASyS, including the ones with observed convulsive ASyS, from 04/01/2012 to 03/31/2018, who completed PROMs within 6 months of hospital discharge. Patient-reported outcome measures, including one Neuro-QoL and six PROMIS v1.0 domain scales, were completed by patients as the standard of care in ambulatory stroke clinics. Since ASMs are sometimes used without clearly diagnosed ASyS, we performed group comparisons based on ASM status at discharge, irrespective of their ASyS status. T-tests or Wilcoxon rank sum tests compared continuous variables across groups and chi-square tests or Fisher's exact tests were used for categorical variables. RESULTS A total of 508 patients were included in the study [mean age 62.0 ± 14.1 years, 51.6% female; 244 (48.0%) ischemic stroke, 165 (32.5%) intracerebral hemorrhage, and 99 (19.5%) subarachnoid hemorrhage]. A total of 190 (37.4%) patients were discharged on ASMs. At the time of the first PROM, conducted a median of 47 (IQR = 33-78) days after the suspected ASyS, and 162 (31.9%) were on ASMs. ASM use was significantly higher in patients diagnosed with ASyS. Physical Function and Satisfaction with Social Roles and Activities were the most affected health domains. Patient-reported outcome measures were not significantly different between groups based on ASyS (electrographic and/or convulsive), ASM use at hospital discharge, or ASM status on the day of PROM completion. SIGNIFICANCE There were no differences in multiple domain-specific PROMs in patients with recent stroke according to ASyS status or ASM use suggesting the possible lack of the former's sensitivity to detect their impact. Additional research is necessary to determine if there is a need for developing ASyS-specific PROMs.
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Affiliation(s)
- Vineet Punia
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Yadi Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Pradeep Chandan
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Christopher Newey
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States; Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Stephen Hantus
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Monika Dhakar
- Rhode Island Hospital, Brown University, United States
| | - Clio Rubinos
- University of North Carolina, Chapel Hill, United States
| | - Sahar Zafar
- Massachusetts General Hospital, Harvard University, United States
| | | | - Irene L Katzan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
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Muacevic A, Adler JR, Deodhe NP. Implementation of the Gamut of Physiotherapy Maneuvers in Restoration and Normalization of Functional Potencies in a Patient With a Hemorrhagic Stroke: A Case Report. Cureus 2022; 14:e33035. [PMID: 36721551 PMCID: PMC9883064 DOI: 10.7759/cureus.33035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
A stroke is a medical emergency characterized by a sudden onset of focal neurological deficits due to an interruption in the blood flow to the brain tissues, with signs and symptoms persisting for more than 24 hours. Motor, sensory, recognition, language, and perceptual deficiencies are typical signs of the disease, depending on the areas affected, the size of the injury, and the origin of the injury. Patients who have had a stroke frequently have problems like weakness, stiffness, and altered movement patterns in addition to poor balance and mobility issues. Numerous physiotherapeutic strategies concentrate on helping stroke victims recover quickly. Stroke-related mortality rates have decreased over the past few decades due to advancements in stroke therapy and rehabilitation. One approach that can be primarily used to normalization of tone is facilitation by Rood's technique. The present case report is of a 45-year-old female with a history of hypertension presented with complaints of weakness on the right side of the body. The patient had right hemiplegia with more involvement of the right upper extremity. The patient underwent a decompressive craniotomy. On investigation, the magnetic resonance imaging (MRI) report revealed an area of blood density attenuation with multiple air foci in the left gangliocapsular region. Treatment was started after the patient was operated on. An approach-oriented rehabilitation program was planned for the patient. Physiotherapy maneuvers such as the proprioceptive neuromuscular facilitation (PNF) approach and Rood's approach were used to restore and normalize functional potencies and recover the patient's condition. Oral facial facilitation was also used for swallowing frequency control, sensory awareness, and motor control. Posttreatment changes such as changes in muscle tone, strength, and mobility, which are essential for patients with the activity of daily living (ADLs), were observed. Outcome measures used in this patient are the Functional Independence of Measures (FIM) scale, Brunnstrom grading, voluntary control grading, and the National Institute of Health Stroke Scale (NIHSS).
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Holtkamp M, Krämer G. Antiepileptic pharmacotherapy in old age: evidence-based approach versus clinical routine – English Version. Z Epileptol 2022. [DOI: 10.1007/s10309-022-00492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ma Y, Zhang J, Wen Y, Chen J, Yuan L, Jiang X, Xu D, Liu K. Diffuse low-grade glioma misdiagnosed as acute cerebral infarction: A case report. Medicine (Baltimore) 2022; 101:e30378. [PMID: 36107508 PMCID: PMC9439775 DOI: 10.1097/md.0000000000030378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Diffuse low-grade gliomas (DLGGs) are relatively rare tumors that are more likely to be misdiagnosed and wrongly treated in clinical practice. We report a case of DLGG detected by computed tomography and magnetic resonance imaging (MRI). PATIENT CONCERNS A 58-year-old man suddenly phantom smells for half an hour and was previously healthy. DIAGNOSES Computed tomography findings showed a leaf-shaped slightly hypodense shadow in the right temporal lobe with no obvious mass effect and an unclear boundary. MRI findings showed diffuse and slightly longer T1-weighted imaging (T1WI)/T2-weighted imaging (T2WI)signal in the right temporal lobe and hippocampus, slight hyperintensity on diffusion-weighted imaging, diffuse swelling in the right temporal lobe and hippocampus, and shallower cerebral sulci and fissures. No obvious abnormal enhancement was observed on enhanced MRI. Contrast-enhanced magnetic resonance angiography showed no obvious abnormality. INTERVENTIONS Intravenous thrombolysis with alteplase (rtPA) was given first. OUTCOMES The patient had an acute and persistent generalized tonic-clonic seizure and was given antiepileptic treatment. Immunopathological and molecular genetic testing diagnosed as DLGGs. After targeted chemotherapy, the patient's symptoms improved significantly. LESSONS For those cases with clinical acute neurological impairment and imaging findings similar to those of ischemic stroke, where the distribution of lesions is inconsistent with the distribution of blood vessels, and the time of onset does not match the imaging findings, the possibility of DLGGs should be considered.
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Affiliation(s)
- Yipo Ma
- Department of Radiology, Taicang City Hospital of Traditional Chinese Medicine, Taicang, Jiangsu, China
| | - Jinfeng Zhang
- Department of Neurology, Taicang City Hospital of Traditional Chinese Medicine, Taicang, Jiangsu, China
| | - Ying Wen
- Department of Neurology, Taicang City Hospital of Traditional Chinese Medicine, Taicang, Jiangsu, China
| | - Jinghua Chen
- Department of Radiology, Taicang City Hospital of Traditional Chinese Medicine, Taicang, Jiangsu, China
| | - Lei Yuan
- Department of Neurology, Taicang City Hospital of Traditional Chinese Medicine, Taicang, Jiangsu, China
| | - Xuechun Jiang
- Department of Cardiology, Taicang City Hospital of Traditional Chinese Medicine, Taicang, Jiangsu, China
| | - Dan Xu
- Department of Neurology, Taicang City Hospital of Traditional Chinese Medicine, Taicang, Jiangsu, China
| | - Kefu Liu
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
- *Correspondence: Kefu Liu, Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, No.242, GuangJi Road, Suzhou, Jiangsu 215008, China (e-mail: )
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Ren Z, Wen Q, Yan X, Wang Y, Zhang Y. Post-stroke epilepsy and risk of all-cause mortality: A systematic review and meta-analysis of cohort studies. Clin Neurol Neurosurg 2022; 220:107362. [PMID: 35839716 DOI: 10.1016/j.clineuro.2022.107362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Post-stroke epilepsy (PSE) has been suggested as a predictor of poor prognosis. We aimed to evaluate the association between PSE and all-cause mortality via a meta-analysis. METHODS Relevant cohort studies were identified by search of electronic databases including PubMed, Embase, and Web of Science. Two authors independently performed database search, data collection, and study quality evaluation. A randomized-effect model incorporating the possible between-study heterogeneity was used to pool the results. RESULTS Overall, ten cohort studies including 177,929 patients with stroke contributed to the meta-analysis. Of them, 15,836 (8.9%) had PSE during a mean follow-up of 4 years. Compared to stroke survivors without PSE, patients with PSE had a significantly increased risk of all-cause death (odds ratio [OR]: 1.68, 95% confidence interval: 1.51-1.87, p < 0.001; I2 = 80%). Subgroup analyses showed consistent association in patients with ischemic and hemorrhagic stroke, in prospective and retrospective studies, in PSE diagnosed as unprovoked seizure occurred more than 7 days and 14 days after stroke, in studies with follow-up durations within or over 5 years, and in studies with different quality scores (p for subgroup effect all < 0.05). The Galbraith plot identified three outlier studies which may contribute to the heterogeneity of the meta-analysis, and all of the three studies were database-linked studies. The between-study heterogeneity was significantly reduced after removing the three database-linked studies (OR: 1.39, 95% CI: 1.18-1.62, p < 0.001; I2 = 0%). CONCLUSION PSE was associated with a higher risk of all-cause mortality.
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Affiliation(s)
- Zhong Ren
- Center of Cerebral Diseases, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130000, China
| | - Quan Wen
- Center of Cerebral Diseases, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130000, China
| | - Xue Yan
- Center of Cerebral Diseases, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130000, China
| | - Ying Wang
- Center of Cerebral Diseases, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130000, China
| | - Yidan Zhang
- Center of Cerebral Diseases, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130000, China.
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12
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Tako LM, Strzelczyk A, Rosenow F, Pfeilschifter W, Steinmetz H, Golbach R, Schäfer JH, Zöllner JP, Kohlhase K. Predictive Factors of Acute Symptomatic Seizures in Patients With Ischemic Stroke Due to Large Vessel Occlusion. Front Neurol 2022; 13:894173. [PMID: 35711262 PMCID: PMC9196034 DOI: 10.3389/fneur.2022.894173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Acute symptomatic seizures (ASz) after ischemic stroke are associated with increased mortality; therefore, identifying predictors of ASz is important. The purpose of this study was to analyze predictors of ASz in a population of patients with ischemic stroke due to large arterial vessel occlusion (LVO). Materials and Methods This retrospective study examined patients with acute ischemic stroke caused by LVO between 2016 and 2020. Identification of predictive factors was performed using univariate and subsequent multiple logistic regression analysis. In addition, subgroup analysis regarding seizure semiology and time of seizure occurrence (≤ 24 h and > 24 h after stroke) was performed. Results The frequency of ASz among 979 patients was 3.9 % (n = 38). Univariate logistic regression analysis revealed an increased risk of ASz in patients with higher National Institutes of Health Stroke Scale (NIHSS) score at admission or 24 h after admission, hypernatremia at admission ≥ 145 mmol/L, and pneumonia. Further multiple logistic regression analysis revealed that NIHSS 24 h after admission was the strongest predictor of ASz, particularly relating to ASz occurring later than 24 h after stroke. Patients who experienced a seizure within the first 24 h after stroke were more likely to have a generalized tonic-clonic (GTCS) and focal motor seizure; beyond 24 h, seizures with impaired awareness and non-convulsive status epilepticus were more frequent. Conclusion NIHSS score 24 h after admission is a strong predictive factor for the occurrence of ASz in patients with ischemic stroke caused by LVO. The semiology of ASz varied over time, with GTCS occurring more frequently in the first 24 h after stroke.
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Affiliation(s)
- Lisa Marie Tako
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Helmuth Steinmetz
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Rejane Golbach
- Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan Hendrik Schäfer
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Johann Philipp Zöllner
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
| | - Konstantin Kohlhase
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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León-Ruiz M, Oliva-Navarro J. Palinopsia with LPDs-plus heralding a posterior-cerebral-artery ischemic stroke: the hidden face of occipital lobe seizures. Acta Neurol Belg 2022; 123:679-682. [PMID: 35426611 DOI: 10.1007/s13760-022-01950-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/30/2022] [Indexed: 11/01/2022]
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Kulesh AA. Net clinical benefit of anticoagulant therapy from a neurologist's perspective: A review. Consilium Medicum 2022. [DOI: 10.26442/20751753.2022.2.201537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this article the concept of "net clinical benefit" (NCB) is considered in the context of stroke, the role of direct oral anticoagulants in secondary prevention of cardioembolic stroke and NCB from their prescription. Practical aspects of NCB evaluation from the neurologist's point of view are presented, taking into account such factors as stroke duration and severity, features of neurological deficit (severity of residual limitations, dysphagia, motor disorders and risk of falls), neuroimaging characteristics of stroke (focal size and hemorrhagic transformation) and concomitant neurological diseases (epilepsy and dementia). In all these situations, the use of oral anticoagulants has a significant clinical benefit, which justifies the inadmissibility of refusal to prescribe them.
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Kohlhase K, Tako LM, Zöllner JP, Golbach R, Pfeilschifter W, Steinmetz H, Rosenow F, Strzelczyk A. Mechanical thrombectomy does not increase the risk of acute symptomatic seizures in patients with an ischaemic stroke: a propensity score matching study. J Neurol. [PMID: 35048192 PMCID: PMC9119889 DOI: 10.1007/s00415-022-10968-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/12/2022]
Abstract
Background Mechanical thrombectomy and systemic thrombolysis are important therapies for stroke patients. However, there is disagreement about the accompanying risk of acute symptomatic seizures. Methods A retrospective analysis of patients with an acute ischaemic stroke caused by large vessel occlusion was performed. The patients were divided into four groups based on whether they received either mechanical thrombectomy (MT) or systemic thrombolysis (ST; group 1: MT+/ST−; group 2: MT+/ST+; group 3: MT−/ST+; group 4: MT−/ST−). Propensity score matching was conducted for each group combination (1:3, 1:4, 2:3, 2:4, 1:2, 3:4) using the covariates “NIHSS at admission”, “mRS prior to event” and “age”. The primary endpoint was defined as the occurrence of acute symptomatic seizures. Results A total of 987 patients met the inclusion criteria, of whom 208, 264, 169 and 346 belonged to groups 1, 2, 3 and 4, respectively. Propensity score matched groups consisted of 160:160, 143:143, 156:156, 144:144, 204:204 and 165:165 patients for the comparisons 1:3, 1:4, 2:3, 2:4, 1:2 and 3:4, respectively. Based on chi-squared tests, there was no significant difference in the frequency of acute symptomatic seizures between the groups. Subgroups varied in their frequency of acute symptomatic seizures, ranging from 2.8 to 3.8%, 2.8–4.4%, 3.6–3.8% and 4.9–6.3% in groups 1, 2, 3 and 4, respectively. Conclusion There was no association between MT or ST and an increased risk of acute symptomatic seizures in patients with an acute ischaemic stroke caused by large vessel occlusion who were treated at a primary stroke centre. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-10968-5.
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