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- Bentes, C., et al.
(författare)
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Reperfusion therapies and poststroke seizures
- 2020
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Ingår i: Epilepsy and Behavior. - : Elsevier BV. - 1525-5050. ; 104
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Tidskriftsartikel (refereegranskat)abstract
- Seizures are not only a frequent complication of stroke but have been associated with an unfavorable functional and vital outcome of patients who have had stroke. Facing a new paradigm of acute standard stroke care, acute symptomatic seizures in this clinical setting deserve to be rethought. Reperfusion therapies, the gold standard treatment for acute ischemic stroke, improve long-term survival and outcome of patients who have had stroke and have been associated both with clinical seizures and the occurrence of epileptiform activity in the electroencephalogram (EEG). This narrative review describes the different physiopathological mechanisms underlying the possible association between reperfusion therapies and seizures, both acute symptomatic seizures and unprovoked seizures, and the current evidence regarding the risk of poststroke seizures in treated patients. It also identifies the gaps in our knowledge to foster future studies in this field. By different mechanisms, reperfusions therapies may have opposing effects on the risk of poststroke seizures. There is a need for a better definition of the specific physiopathology of seizures in clinical practice, as many factors can be recognized. Additionally, most of the current clinical evidence refers to acute symptomatic seizures and not to unprovoked seizures or poststroke epilepsy, and our analysis does not support the existence of a strong association between thrombolysis and poststroke seizures. So far, the impact of reperfusion therapies on the frequency of poststroke seizures is unclear. To study this effect, many clinical challenges must be overcome, including a better and clear operational definition of seizures and stroke characteristics, the standard of stroke and epilepsy care and EEG monitoring, and the degree of reperfusion success. Prospective, high quality, larger, and longer follow-up multicentric studies are urgently needed. Additionally, stroke registries can also prove useful in better elucidate whether there is an association between reperfusion therapies and seizures. Seizures & Stroke. © 2019 Elsevier Inc.
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- Brigo, F, et al.
(författare)
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Randomized controlled trials of antiepileptic drugs for the treatment of post-stroke seizures: A systematic review with network meta-analysis.
- 2018
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Ingår i: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 61, s. 57-62
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Tidskriftsartikel (refereegranskat)abstract
- To determine the best available evidence on the efficacy and tolerability of antiepileptic drugs (AEDs) used to treat poststroke seizures and epilepsy.MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and Opengrey.eu were searched for RCTs of AEDs used to treat post-stroke epilepsy. The following outcomes were considered: seizure freedom; occurrence of adverse effects (AEs); withdrawal for AEs. The methodological quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Adjusted indirect comparisons were made between each AED using controlled-release carbamazepine (CR-CBZ) as common comparator.Only 2 RCTs were included, one comparing levetiracetam (LEV) with CR-CBZ and the other comparing lamotrigine (LTG) with CR-CBZ. No significant difference was found in seizure freedom between either LEV or LTG and CR-CBZ. Occurrence of AEs were lower for LEV and LTG than for CR-CBZ. Indirect comparisons showed no difference between LEV and LTG for seizure freedom (OR 0.86; 95%CI: 0.15-4.89). Occurrence of AEs was higher for LEV than for LTG (OR 6.87; 95%CI: 1.15-41.1). For withdrawal rates due to AEs, we found a large width and asymmetrical distribution of confidence intervals around the obtained OR of 10.8 (95% CI: 0.78-149.71).Direct and indirect comparisons did not find a difference in seizure freedom between the various AEDs, probably because of the small number of patients included. LEV and LTG appears better tolerated than CR-CBZ and LEV seems associated with more AEs than LTG. Further studies are required to provide robust evidence on efficacy and tolerability of AEDs for treating poststroke epilepsy.
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- Mahamud, Zamzam, et al.
(författare)
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Risk of epilepsy diagnosis after a first unprovoked seizure in dementia
- 2020
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Ingår i: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 82, s. 118-124
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To estimate the risk of an epilepsy diagnosis after a first unprovoked seizure in dementia, in relation to the 60 % cut-off specified in the ILAE definition of epilepsy. Methods: The study was register-based. Individuals with diagnostic codes of a first unprovoked seizure were identified in the Swedish Dementia Register (SveDem) or a three times larger ageand sexmatched pool of controls (n = 1039 in SveDem and 743 controls). The risk of a diagnostic code for epilepsy was estimated by Kaplan Meier analysis. Results: The 5-year risk of a subsequent epilepsy diagnosis after a first unprovoked seizure was 32 % (95 % CI 27-37) in patients with dementia and 31 % (95 % CI 25-38) in controls. The 5-year risk of epilepsy was 48 % (95 % CI 37-59) for individuals age 70 years or below. The dementia subtype with the highest risk of epilepsy was early onset Alzheimer. Conclusion: The risk of an epilepsy diagnosis after a first unprovoked seizure is similar in patients with dementia and in controls. Our results indicate that epilepsy cannot be diagnosed after a first seizure simply on the basis of the patient having dementia. Instead, more studies are needed for individualized prediction of recurrence risk in dementia. Such studies should focus on particular dementia subtypes, younger patients, and identifying biomarkers.
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- Zelano, Johan, 1981, et al.
(författare)
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How to diagnose and treat post-stroke seizures and epilepsy
- 2020
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Ingår i: Epileptic Disorders. - : Wiley. - 1294-9361 .- 1950-6945. ; 22:3, s. 252-263
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Tidskriftsartikel (refereegranskat)abstract
- Stroke is one of the commonest causes of seizures and epilepsy, mainly among the elderly and adults. This seminar paper aims to provide an updated overview of post-stroke seizures and post-stroke epilepsy (PSE) and offers clinical guidance to anyone involved in the treatment of patients with seizures and stroke. The distinction between acute symptomatic seizures occurring within seven days from stroke (early seizures) and unprovoked seizures occurring afterwards (late seizures) is crucial regarding their different risks of recurrence. Asingle late post-stroke seizure carries a risk of recurrence as high as 71.5% (95% confidence interval: 59.7-81.9) at ten years and is diagnostic of PSE. Several clinical and stroke characteristics are associated with increased risk of post-stroke seizures and PSE. So far, there is no evidence supporting the administration of antiepileptic drugs as primary prevention, and evidence regarding their use in PSE is scarce.
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- Zelano, Johan, 1981, et al.
(författare)
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Increased risk of epilepsy in patients registered in the Swedish Dementia Registry
- 2020
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 27:1, s. 129-135
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Data on epilepsy in dementia, particularly on its risk factors, are scarce. Confounding comorbidities and the rising incidence of epilepsy in older age have hampered studies in this field. The occurrence and risk factors for epilepsy in the Swedish Dementia Registry (SveDem), a large cohort of patients with dementia, have been examined. Methods Information on epilepsy and seizure-related diagnoses, comorbidities and survival were extracted for all individuals in SveDem (n = 81 192) and three randomly selected age- and gender-matched controls from the population register, excluding all with a dementia diagnosis (n = 223 933). The risk of epilepsy following dementia diagnosis was estimated with Kaplan-Meier curves, and Cox proportional hazard modelling was used to identify risk factors and adjust for comorbidities. Results A diagnosis of epilepsy was found more frequently amongst dementia patients [4.0%, 95% confidence interval (CI) 3.8-4.1] than controls (1.9%, 95% CI 1.9-2.0). The risk of incident epilepsy after dementia was 2.1% (95% CI 1.9-2.3) at 5 years and 4.0% (95%CI 3.4-4.6) at 10 years, compared to 0.8% (95% CI 0.8-0.8) and 1.6% (95% CI 1.4-1.8) respectively for controls. The risk was greatest for early-onset Alzheimer's disease. In multivariate analysis, dementia was associated with a hazard ratio of 2.52 (95% CI 2.31-2.74) for epilepsy. Young age, male sex, stroke, brain trauma, brain tumour and low Mini-Mental State Examination score significantly increased the risk. Conclusions Dementia, particularly young-onset Alzheimer's disease, increases the risk of subsequent epilepsy. Further studies are needed to determine optimal management and the impact of epilepsy on prognosis.
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