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. 2022 May 27:13:894173.
doi: 10.3389/fneur.2022.894173. eCollection 2022.

Predictive Factors of Acute Symptomatic Seizures in Patients With Ischemic Stroke Due to Large Vessel Occlusion

Lisa Marie Tako  1   2 , Adam Strzelczyk  1   2 , Felix Rosenow  1   2 , Waltraud Pfeilschifter  3 , Helmuth Steinmetz  1 , Rejane Golbach  4 , Jan Hendrik Schäfer  1 , Johann Philipp Zöllner  1   2 , Konstantin Kohlhase  1
Affiliations

Predictive Factors of Acute Symptomatic Seizures in Patients With Ischemic Stroke Due to Large Vessel Occlusion

Lisa Marie Tako et al. Front Neurol. .

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.

Keywords: epilepsy; intravenous thrombolysis; mechanical recanalization; seizure; stroke unit.

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Conflict of interest statement

AS reports personal fees and grants from Angelini Pharma, Desitin Arzneimittel, Eisai, GW Pharmaceuticals, Marinus Pharma, Precisis, UCB, UNEEG Medical, and Zogenix, outside the scope of the submitted manuscript. FR reports personal fees from Angelini Pharma/Arvelle Therapeutics, Eisai GmbH, GW Pharmaceuticals/Jazz Pharma, and UCB Pharma and grants from the Detlev-Wrobel-Fonds for Epilepsy Research, the Deutsche Forschungsgemeinschaft (DFG), the Federal Ministry of Education and Research (BMBF), the LOEWE Programme of the State of Hesse, and the European Union, outside the scope of the submitted manuscript. JZ reports speaker's honoraria from Desitin Arzneimittel, Eisai and GW Pharmaceuticals, outside the scope of the submitted manuscript. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Results of the multiple regression analysis. Red squares represent the odds ratio and blue horizontal bars represent the 95% confidence interval. NIHSS, National Institutes of Health Stroke Scale.
See this image and copyright information in PMC

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