Analysis of risk factors for seizure recurrence in patients with post-stroke epilepsy_Journal of Epilepsy

Authors：

GUO Yijia , GUO Jian , ZHOU Muke , ZHOU Dong ,  HE Li

Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

HE Li, Email: heli2003new@126.com

Keywords：

Ischemic stroke; Epilepsy; Recurrence; Risk factors

DOI：

10.7507/2096-0247.20170073

Video：

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Objective The purpose of this study was to investigate clinical aspects as risk factors for seizure recurrence in patients with post-stroke epilepsy. Methods During January 2010 to April 2016, patients admitted into Department of Neurology, West China Hospital were retrospectively selected. Inpatients diagnosed as epilepsy following stoke and attending our follow-up were participated in this study. Logistic regression model was used to analyze the risk factors of seizure recurrence. Results We included 105 patients with diagnosis of post-stroke epilepsy, among them, 59.0% were male and the median age was 72 years. Median time from stroke onset to seizure attack was 180 days. Approximately 80% patients received antiepileptic drugs(AEDs). During 720 days follow-up period, 70% patients reported without seizure attack. Risk factors significantly associated with seizure recurrence were younger age [OR=3.03, 95 % CI(1.19, 7.76), P=0.02], poor modified Rankin Scale score [OR=3.01, 95 % CI(1.1, 8.18), P=0.03] and using more than two kinds of AEDs [OR=3.85, 95 % CI(1.3, 11.18), P=0.01]. Conclusions In the clinical course of post-stroke epilepsy, clinicians should realize the management for primary disease to alleviate stroke sequel and select rational AEDs to reduce seizure recurrence.

Citation： GUO Yijia, GUO Jian, ZHOU Muke, ZHOU Dong, HE Li. Analysis of risk factors for seizure recurrence in patients with post-stroke epilepsy. Journal of Epilepsy, 2017, 3(6): 465-469. doi: 10.7507/2096-0247.20170073 Copy

1.	Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in rochester, minnesota: 1935-1984. Epilepsia, 1993, 34(3): 453-468.
2.	Pitkanen A, Roivainen R, Lukasiuk K. Development of epilepsy after ischaemic stroke. Lancet Neurol, 2016, 15(2): 185-197.
3.	Huang CW, Saposnik G, Fang J, et al. Influence of seizures on stroke outcomes:a large multicenter study. Neurology, 2014, 82(9): 768-776.
4.	Zelano J, Lundberg RG, Baars L, et al. Clinical course of poststroke epilepsy:a retrospective nested case-control study. Brain Behav, 2015, 5(9): e00366.
5.	Strozzi I, Nolan SJ, Sperling MR, et al. Early versus late antiepileptic drug withdrawal for people with epilepsy in remission. Cochrane Database Syst Rev, 2015, 11(2): Cd001902.
6.	Bryndziar T, Sedova P, Kramer NM, et al. Seizures following ischemic stroke: frequency of occurrence and impact on outcome ina long-term population-based study.J Stroke Cerebrovasc Dis, 2016, 25(1): 150-156.
7.	Alvarez-Sabin J, Montaner J, Padro L, et al. Gabapentin in late-onset poststroke seizures. Neurology, 2002, 59(12): 1991-1993.
8.	Gilad R, Sadeh M, Rapoport A, et al. Monotherapy of lamotrigine versus carbamazepine in patients with poststroke seizure. Clin Neuropharmacol, 2007, 30(4): 189-195.
9.	Kutlu G, Gomceli YB, Unal Y, et al. Levetiracetam monotherapy for late poststroke seizures in the elderly. Epilepsy Behav, 2008, 13(3): 542-544.
10.	Garcia-Escriva A, Lopez-Hernandez N. The use of levetiracetam in monotherapy in post-stroke seizures in the elderly population. Rev Neurol, 2007, 45(9): 523-525.
11.	Consoli D, Bosco D, Postorino P, et al. Levetiracetam versus carbamazepine in patients with late poststroke seizures:a multicenter prospective randomized open-label study. Cerebrovasc Dis, 2012, 34(4): 282-289.
12.	Tanaka T, Yamagami H, Ihara M, et al. Seizure outcomes and predictors of recurrent post-stroke seizure:a retrospective observational cohort study. PloS One, 2015, 10(8): e0136200.
13.	Huang C, Feng L, Li YH, et al. Clinical features and prognosis of epilepsy in the elderly in western China. Seizure, 2016, 38: 26-31.
14.	Stephen LJ. Drug treatment of epilepsy in elderly people: focus on valproic acid. Drugs Aging, 2003, 20(2): 141-152.
15.	Ferlazzo E, Sueri C, Gasparini S, et al. Challenges in the pharmacological management of epilepsy and its causes in the elderly. Pharmacol Res, 2016, 106(4): 21-26.
16.	Wang JZ, Vyas MV, Saposnik G, et al. Incidence and management of seizures after ischemic stroke: systematic review and meta-analysis. Neurology, 2017, 89(12): 1220-1228.
17.	Glauser T, Ben-Menachem E, Bourgeois B, et al. Updated ilae evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia, 2013, 54(3): 551-563.
18.	Lamy C, Domigo V, Semah F, et al. Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology, 2003, 60(3): 400-404.
19.	Horner S, Ni XS, Duft M, et al. EEG, CT and neurosonographic findings in patients with postischemic seizures.J Neurol Sci, 1995, 132(1): 57-60.
20.	Leung T, Leung H, Soo YO, et al. The prognosis of acute symptomatic seizures after ischaemic stroke.J Neurol Neurosurg Psychiatry, 2017, 88(1): 86-94.

1. Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in rochester, minnesota: 1935-1984. Epilepsia, 1993, 34(3): 453-468.
2. Pitkanen A, Roivainen R, Lukasiuk K. Development of epilepsy after ischaemic stroke. Lancet Neurol, 2016, 15(2): 185-197.
3. Huang CW, Saposnik G, Fang J, et al. Influence of seizures on stroke outcomes:a large multicenter study. Neurology, 2014, 82(9): 768-776.
4. Zelano J, Lundberg RG, Baars L, et al. Clinical course of poststroke epilepsy:a retrospective nested case-control study. Brain Behav, 2015, 5(9): e00366.
5. Strozzi I, Nolan SJ, Sperling MR, et al. Early versus late antiepileptic drug withdrawal for people with epilepsy in remission. Cochrane Database Syst Rev, 2015, 11(2): Cd001902.
6. Bryndziar T, Sedova P, Kramer NM, et al. Seizures following ischemic stroke: frequency of occurrence and impact on outcome ina long-term population-based study.J Stroke Cerebrovasc Dis, 2016, 25(1): 150-156.
7. Alvarez-Sabin J, Montaner J, Padro L, et al. Gabapentin in late-onset poststroke seizures. Neurology, 2002, 59(12): 1991-1993.
8. Gilad R, Sadeh M, Rapoport A, et al. Monotherapy of lamotrigine versus carbamazepine in patients with poststroke seizure. Clin Neuropharmacol, 2007, 30(4): 189-195.
9. Kutlu G, Gomceli YB, Unal Y, et al. Levetiracetam monotherapy for late poststroke seizures in the elderly. Epilepsy Behav, 2008, 13(3): 542-544.
10. Garcia-Escriva A, Lopez-Hernandez N. The use of levetiracetam in monotherapy in post-stroke seizures in the elderly population. Rev Neurol, 2007, 45(9): 523-525.
11. Consoli D, Bosco D, Postorino P, et al. Levetiracetam versus carbamazepine in patients with late poststroke seizures:a multicenter prospective randomized open-label study. Cerebrovasc Dis, 2012, 34(4): 282-289.
12. Tanaka T, Yamagami H, Ihara M, et al. Seizure outcomes and predictors of recurrent post-stroke seizure:a retrospective observational cohort study. PloS One, 2015, 10(8): e0136200.
13. Huang C, Feng L, Li YH, et al. Clinical features and prognosis of epilepsy in the elderly in western China. Seizure, 2016, 38: 26-31.
14. Stephen LJ. Drug treatment of epilepsy in elderly people: focus on valproic acid. Drugs Aging, 2003, 20(2): 141-152.
15. Ferlazzo E, Sueri C, Gasparini S, et al. Challenges in the pharmacological management of epilepsy and its causes in the elderly. Pharmacol Res, 2016, 106(4): 21-26.
16. Wang JZ, Vyas MV, Saposnik G, et al. Incidence and management of seizures after ischemic stroke: systematic review and meta-analysis. Neurology, 2017, 89(12): 1220-1228.
17. Glauser T, Ben-Menachem E, Bourgeois B, et al. Updated ilae evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia, 2013, 54(3): 551-563.
18. Lamy C, Domigo V, Semah F, et al. Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology, 2003, 60(3): 400-404.
19. Horner S, Ni XS, Duft M, et al. EEG, CT and neurosonographic findings in patients with postischemic seizures.J Neurol Sci, 1995, 132(1): 57-60.
20. Leung T, Leung H, Soo YO, et al. The prognosis of acute symptomatic seizures after ischaemic stroke.J Neurol Neurosurg Psychiatry, 2017, 88(1): 86-94.

Journal of Epilepsy

Analysis of risk factors for seizure recurrence in patients with post-stroke epilepsy

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