Study on Poststroke Seizures

USA: One in 15 (6%) of ischemic stroke patients treated with reperfusion therapy develop seizures, regardless of the type of therapy, according to a recent study in the journal Stroke.

The choice of reperfusion therapy may be influenced by the balance of harms and benefits. Post-stroke seizures increase the risk of poor outcomes and death. Alain Lekoubou, Penn State University, Hershey, PA, and colleagues performed a systematic review and meta-analysis to assess the risk of incidence of seizures after acute stroke reperfusion therapy -- intravenous thrombolysis [IVT] with r-tPA [recombinant tissue-type plasminogen activator], mechanical thrombectomy or both.

The researchers searched online databases for articles published between 1995 and October 28, 2019. The primary outcome was the overall and treatment-specific pooled incidence of poststroke seizures (PSS) following acute reperfusion therapy. The pooled incidence of early poststroke seizures and late poststroke seizures was also computed separately for all studies. The researchers derived the PSS risk associated with IVT in the pooled cohort of patients who received only IVT.

The small number of studies (<3) that reported on the PSS risk associated with mechanical thrombectomy alone or in combination with IVT did not allow the researchers to compute an estimate of the risk of seizures associated with this therapy. A total of 13,753 patients were identified. They had a stroke, of which 592 had seizures.

Key Findings of the Study

• The pooled incidence of PSS was 5.9%.
• PSS incidence rates among patients with stroke treated with IVT, mechanical thrombectomy, and both were respectively 6.1%, 5.9%, and 5.8%.
• The incidence of late PSS was 6.7% and that of early PSS was 3.14%.
• The pooled odds ratio for the association between IVT and PSS was 1.24.

"The findings of this meta-analysis suggest that about one in 15 ischemic stroke patients treated with IVT, mechanical thrombectomy, or both develop seizures independently of the specific reperfusion treatment that they received," concluded the authors.

The study, "Incidence and Association of Reperfusion Therapies With Poststroke Seizures: A Systematic Review and Meta-Analysis," is published in the journal Stroke.

DOI: https://doi.org/10.1161/STROKEAHA.119.028899