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Acute seizures in acute ischemic stroke: does thrombolysis have a role to play?

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Abstract

Seizures appear at stroke presentation, during the acute phase or as a late complication of stroke. Thrombolysis has not been investigated as a risk factor despite its potential neurotoxic effect. We try to identify risk factors for seizures during the acute phase of ischemic stroke in a cohort including thrombolysed patients. We undertook a case–control study at a single stroke center using data from Acute Stroke Registry and Analyse of Lausanne (ASTRAL). Patients with seizure occurring during the first 7 days following stroke were retrospectively identified. Bi-variable and multivariable statistical analyses were applied to compare cases and randomly selected controls. We identified 28 patients experiencing from seizures in 2,327 acute ischemic strokes (1.2 %). All seizures occurred during the first 72 h. Cortical involvement, thrombolysis with rt-PA, arterial recanalization, and higher initial NIHSS were statistically associated with seizures in univariated analysis. Backward linear regression identified cortical involvement (OR 7.53, 95 % CI 1.6–35.2, p < 0.01) and thrombolysis (OR 4.6, 95 % CI 1.6–13.4, p = 0.01) as being independently associated with seizure occurrence. Overall, 3-month outcome measured by the modified Rankin scale (mRS) was comparable in both groups. In the subgroup of thrombolysed patients, outcome was significantly worse at 3 months in the seizure group with 9/12 (75 %) patients with mRS ≥3, compared to 6/18 (33.3 %) in the seizure-free group (p = 0.03). Acute seizures in acute ischemic stroke were relatively infrequent. Cortical involvement and thrombolysis with rt-PA are the principal risk factors. Seizures have a potential negative influence on clinical outcome in thrombolysed patients.

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Conflicts of interest

Vincent Alvarez: nothing to disclose. Andrea O. Rossetti: research support: Pfizer, UCB, Sandoz, EISAI, and GSK. Patrik Michel: research support: Lundbeck Europe, consulting: Lundbeck Europe, Boehringer-Ingelheim, Bayer.

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Authors and Affiliations

  1. Department of Clinical Neurosciences, Service de Neurologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, CHUV BH-07, 1011, Lausanne, Switzerland

    Vincent Alvarez, Andrea O. Rossetti, Vasileios Papavasileiou & Patrik Michel

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  1. Vincent Alvarez
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  2. Andrea O. Rossetti
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  3. Vasileios Papavasileiou
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  4. Patrik Michel
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Correspondence to Vincent Alvarez.

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Alvarez, V., Rossetti, A.O., Papavasileiou, V. et al. Acute seizures in acute ischemic stroke: does thrombolysis have a role to play?. J Neurol 260, 55–61 (2013). https://doi.org/10.1007/s00415-012-6583-6

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  • DOI: https://doi.org/10.1007/s00415-012-6583-6

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