Key points Are patients with post-stroke seizures (PSS) at increased risk of mortality, poor functional outcomes, recurrent strokes, and dementia compared to patients without PSS? Findings This systematic review and meta-analysis of 71 studies and 20,110 patients with PSS suggests that PSS are associated with an increased risk of mortality, poor functional outcomes, disability, and dementia. This study also identifies limitations in existing research on PSS, for example, lack of common data elements, relevant outcome definitions, and reporting standards. Meaning The findings highlight that PSS are a public health problem and warrant important research efforts to prevent post-stroke epileptogenesis. |
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Results from a new study suggest that post-stroke seizures (PSS) may be associated with significantly increased mortality and severe disability among patients with a history of stroke.
The study aimed to better understand outcomes in people experiencing PSS compared to people without PSS by measuring mortality, poor functional outcome (modified Rankin Scale [mRS] score of 3 to 6), disability (mRS score media), recurrent strokes, and dementia at follow-up.
"Previous studies have indicated that epileptic seizures negatively affect the functional, neurological, and cognitive outcomes of stroke patients," the researchers wrote. "However, the published data are inconsistent and, to our knowledge, have not been systematically evaluated."
The researchers searched databases for eligible studies from 1951 to January 30, 2023, including MEDLINE, Embase, PsycInfo, Cochrane, and others. The studies included patients aged 18 years or older with a history of stroke, presenting with early or late PSS. Studies of patients with a history of seizures before the index stroke were excluded. Additionally, a subgroup analysis was performed to examine outcomes in patients with ischemic and hemorrhagic strokes separately.
In total, 71 studies were included in the analysis, including 1 bidirectional, 20 prospective, 47 retrospective, and 3 case-control studies. Additionally, all studies were published in English and included patients from 31 countries.
The studies included 20,110 patients with PSS and 1,166,085 patients without PSS. Of these PSS patients, 1,967 (9.8%) had early seizures, 10,605 (52.7%) had late seizures after stroke, and 7,538 (37.5%) had seizures that were not defined as either early or late. .
Post-stroke seizures (PSS) were defined according to data from clinical or medical records in 59 studies using International Statistical Classification of Diseases Tenth Revision codes in 12 studies.
Additionally, post-stroke seizures (PSS) were associated with an increased risk of mortality (odds ratio [OR], 2.1; 95% CI, 1.8-2.4), poor functional outcome (OR, 2.2; 95% CI, 1.8-2.8), greater disability (SMD, 0.6; 95% CI, 0.4-0.7), and greater risk of dementia (OR, 3.1 ; 95% CI, 1.3-7.7) compared to no PSS.
In subgroup analyses, early seizures were associated with mortality (OR, 2.4; 95% CI, 1.9-2.9), but late seizures were not (OR, 1.2; 95% CI %, 0.8-2.0), and both ischemic (OR, 2.2; 95% CI, 1.8-2.7) and hemorrhagic stroke (OR, 1.4; 95% CI, 1 .0-1.8) were associated with mortality.
Additionally, early (OR, 2.4; 95% CI, 1.6-3.4) and late (OR, 2.7; 95% CI, 1.8-4.1), ischemic (OR , 2.6; 95% CI, 1.9-3.7) and hemorrhagic. (OR, 1.9; 95% CI, 1.0-3.6) were associated with poor outcomes.
However, the researchers acknowledged some limitations of the study, including having few data from prospective studies, few studies with outcome data categorized by seizure or stroke subtype, and not having enough data to evaluate the effect of stroke severity on outcomes after post-stroke seizures (PSS), which the researchers believe could have been a potential confounder.
Despite these limitations, the researchers believe the study shows that post-stroke seizures (PSS) are associated with a doubled risk of death and serious disability. Additionally, the researchers identified significant variability in reporting standards across these studies and suggest how collaborative efforts and future research should work to address these challenges.
"Unraveling these associations is a high clinical and research priority," the researchers wrote. "Trials of interventions to prevent seizures may be warranted."
Conclusions and relevance The results of this systematic review and meta-analysis suggest that post-stroke seizures (PSS) were associated with a significantly increased mortality and severe disability in patients with a history of stroke. Unraveling these associations is a high clinical and research priority. Trials of interventions to prevent seizures may be warranted. |
This systemic review and meta-analysis was published in JAMA Neurology .
