Association of the timing and type of acute symptomatic seizures with poststroke epilepsy and mortality: clinical and population sciences
BACKGROUND: - Acute symptomatic seizures (ASyS) increase the risk of epilepsy and mortality after a stroke. The impact of the timing and type of ASyS remains unclear. - METHODS: - This multicenter cohort study included data from 9 centers between 2002 and 2018, with a final analysis in February 2024...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
July 2025
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| In: |
Stroke
Year: 2025, Volume: 56, Issue: 7, Pages: 1748-1757 |
| ISSN: | 1524-4628 |
| DOI: | 10.1161/STROKEAHA.124.050045 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1161/STROKEAHA.124.050045 Verlag, lizenzpflichtig, Volltext: http://www.ahajournals.org/doi/10.1161/STROKEAHA.124.050045 
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| Author Notes: | Kai Michael Schubert, MD, PhD, Dominik Zieglgänsberger, MD, Giulio Bicciato, MD, Laura Abraira, MD, PhD, Estevo Santamarina, MD, José Álvarez-Sabín, PhD, Carolina Ferreira-Atuesta, MD, MSc, Mira Katan, MD, MSc, Lucia Sinka, MD, Robert Terziev, MD, Nico Deligas, MD, Barbara Erdélyi-Canavese, MD, Ansgar Felbecker, MD, Philip Siebel, MD, Michael Winklehner, MD, Tim J. von Oertzen, MD, Judith N. Wagner, MD, Gian Luigi Gigli, MD, Annacarmen Nilo, MD, Francesco Janes, MD, PhD, Giovanni Merlino, MD, PhD, Mariarosaria Valente, MD, María Paula Zafra-Sierra, MD, Luis Carlos Mayor-Romero, MD, Julian Conrad, MD, Stefan Evers , MD, PhD, Matias Alet, MD, Kazuki Fukuma, MD, PhD, Masafumi Ihara, MD, PhD, Benjamin Landau, MD, Piergiorgio Lochner, MD, Frauke Roell, MD, Francesco Brigo, MD, Carla Bentes, PhD, Ana Rita Peralta, MD, Teresa Pinho e Melo, MD, Mark R. Keezer, MDCM, PhD, John S. Duncan, FMedSc, Josemir W. Sander, FMedSci, Barbara Tettenborn, MD, Matthias J. Koepp, MD, PhD, Marian Galovic, MD, PhD |
| Summary: | BACKGROUND: - Acute symptomatic seizures (ASyS) increase the risk of epilepsy and mortality after a stroke. The impact of the timing and type of ASyS remains unclear. - METHODS: - This multicenter cohort study included data from 9 centers between 2002 and 2018, with a final analysis in February 2024. The study included 4552 adults (2005 female; median age, 73 years) with ischemic stroke and no seizure history. Seizures were classified using International League Against Epilepsy definitions. We examined ASyS occurring within 7 days after stroke. The main outcomes were all-cause mortality and epilepsy. Validation of the updated SeLECT score (SeLECT-ASyS) was performed in 3 independent cohorts (Switzerland, Argentina, and Japan) collected between 2012 and 2024, including 74 adults with ASyS. - RESULTS: - The 10-year risk of poststroke epilepsy ranged from 41% to 94%, and mortality from 36% to 100%, depending on ASyS type and timing. ASyS on stroke onset day had a higher epilepsy risk (adjusted hazard ratio [aHR], 2.3 [95% CI, 1.3-4.0]; P=0.003) compared with later ASyS. Status epilepticus had the highest epilepsy risk (aHR, 9.6 [95% CI, 3.5-26.7]; P<0.001), followed by focal to bilateral tonic-clonic seizures (aHR, 3.4 [95% CI, 1.9-6.3]; P<0.001). Mortality was higher in those with ASyS presenting as focal to bilateral tonic-clonic seizures on day 0 (aHR, 2.8 [95% CI, 1.4-5.6]; P=0.004) and status epilepticus (aHR, 14.2 [95% CI, 3.5-58.8]; P<0.001). The updated SeLECT-ASyS model, available as an application, outperformed a previous model in the derivation cohort (concordance statistics, 0.68 versus 0.58; P=0.02) and in the validation cohort (0.70 versus 0.50; P=0.18). - CONCLUSIONS: - ASyS timing and type significantly affect epilepsy and mortality risk after stroke, improving epilepsy prediction and guiding patient counseling. |
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| Item Description: | Online veröffentlicht: 24. April 2025 Gesehen am 16.09.2025 |
| Physical Description: | Online Resource |
| ISSN: | 1524-4628 |
| DOI: | 10.1161/STROKEAHA.124.050045 |