Association between different acute stroke therapies and development of post stroke seizures

Jillian Naylor; Arthur Thevathasan; Leonid Churilov; Ruibing Guo; Yunyun Xiong; Miriam Koome; Ziyi Chen; Ziyuan Chen; Xinfeng Liu; Patrick Kwan; Bruce C V Campbell

doi:10.1186/s12883-018-1064-x

Association between different acute stroke therapies and development of post stroke seizures

BMC Neurol. 2018 May 3;18(1):61. doi: 10.1186/s12883-018-1064-x.

Authors

Jillian Naylor^{1

2}, Arthur Thevathasan³, Leonid Churilov⁴, Ruibing Guo⁵, Yunyun Xiong⁵, Miriam Koome³, Ziyi Chen⁶, Ziyuan Chen³, Xinfeng Liu⁵, Patrick Kwan³, Bruce C V Campbell³

Affiliations

¹ Melbourne Brain Centre, Royal Melbourne Hospital and Department of Neurology, University of Melbourne, Parkville, Melbourne, Australia. jnaylor@student.unimelb.edu.au.
² Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia. jnaylor@student.unimelb.edu.au.
³ Melbourne Brain Centre, Royal Melbourne Hospital and Department of Neurology, University of Melbourne, Parkville, Melbourne, Australia.
⁴ The Florey Institute of Neuroscience and Mental Heath, University of Melbourne, Parkville, Melbourne, Australia.
⁵ Department of Neurology, Jingling Hospital, Medical School of Nanjing University, Nanjing, China.
⁶ Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Abstract

Background: Epilepsy is a major complication of stroke. We aimed to establish whether there is an association between intravenous thrombolysis, intra-arterial thrombolysis and post stroke seizure (PSS) development. Improved understanding of the relationship between reperfusion therapies and seizure development may improve post-stroke monitoring and follow-up.

Methods: This was a retrospective, multicentre cohort study conducted at the Royal Melbourne Hospital and Jingling Hospital Nanjing. We included patients with anterior circulation ischemic stroke admitted 2008-2015. Patients were divided into four treatment groups 1. IV-tPA only, 2. Intra-arterial therapies (IAT) only, 3. IAT + IV-tPA and 4. stroke unit care only (i.e. no IV-tPA or IAT). To assess the association between type of reperfusion treatment and seizure incidence we used multivariable logistic regression models adjusted for age, stroke severity, 3-month functional outcome and prognostic factors.

Results: There were 1375 stroke unit care-only patients, of whom 28 (2%) developed PSS. There were 363 patients who received only IV-tPA, of whom 21 (5.8%) developed PSS. There were 93 patients who received IAT only, of whom 12 (12.9%) developed PSS and 112 that received both IV-tPA + IAT, of which 5 (4.5%) developed PSS. All reperfusion treatments were associated with seizure development compared to stroke unit care-only patients: IV-tPA only adjusted odds ratio (aOR) 3.7, 95%CI 1.8-7.4, p < 0.0001; IAT aOR 5.5, 95%CI 2.1-14.3, p < 0.0001, IAT + IV-tPA aOR 3.4, 95% CI 0.98-11.8, p = 0.05. These aORs did not differ significantly between treatment groups (IV-tPA + IAT versus IV-tPA p = 0.89, IV-tPA + IAT versus IAT, p = 0.44).

Conclusions: Patients receiving thrombolytic or intra-arterial reperfusion therapies for acute ischemic stroke are at higher risk of epilepsy and may benefit from longer follow-up. No evidence for an additive or synergistic effect of treatment modality on seizure development was found.

Keywords: Intra-arterial thrombectomy; Intravenous tissue plasminogen activator; Ischemic stroke; Post stroke seizures.

Publication types

Multicenter Study

MeSH terms

Administration, Intravenous
Aged
Cohort Studies
Female
Fibrinolytic Agents / adverse effects*
Fibrinolytic Agents / therapeutic use
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Retrospective Studies
Seizures / etiology*
Stroke / therapy*
Thrombectomy / adverse effects*
Thrombolytic Therapy / adverse effects*
Thrombolytic Therapy / methods
Tissue Plasminogen Activator / adverse effects

Substances

Fibrinolytic Agents
Tissue Plasminogen Activator