Tako Lisa Marie, Strzelczyk Adam, Rosenow Felix, Pfeilschifter Waltraud, Steinmetz Helmuth, Golbach Rejane, Schäfer Jan Hendrik, Zöllner Johann Philipp, Kohlhase Konstantin
Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany.
Front Neurol. 2022 May 27;13:894173. doi: 10.3389/fneur.2022.894173. eCollection 2022.
Acute symptomatic seizures (ASz) after ischemic stroke are associated with increased mortality; therefore, identifying predictors of ASz is important. The purpose of this study was to analyze predictors of ASz in a population of patients with ischemic stroke due to large arterial vessel occlusion (LVO).
This retrospective study examined patients with acute ischemic stroke caused by LVO between 2016 and 2020. Identification of predictive factors was performed using univariate and subsequent multiple logistic regression analysis. In addition, subgroup analysis regarding seizure semiology and time of seizure occurrence (≤ 24 h and > 24 h after stroke) was performed.
The frequency of ASz among 979 patients was 3.9 % ( = 38). Univariate logistic regression analysis revealed an increased risk of ASz in patients with higher National Institutes of Health Stroke Scale (NIHSS) score at admission or 24 h after admission, hypernatremia at admission ≥ 145 mmol/L, and pneumonia. Further multiple logistic regression analysis revealed that NIHSS 24 h after admission was the strongest predictor of ASz, particularly relating to ASz occurring later than 24 h after stroke. Patients who experienced a seizure within the first 24 h after stroke were more likely to have a generalized tonic-clonic (GTCS) and focal motor seizure; beyond 24 h, seizures with impaired awareness and non-convulsive status epilepticus were more frequent.
NIHSS score 24 h after admission is a strong predictive factor for the occurrence of ASz in patients with ischemic stroke caused by LVO. The semiology of ASz varied over time, with GTCS occurring more frequently in the first 24 h after stroke.
缺血性卒中后的急性症状性癫痫发作（ASz）与死亡率增加相关；因此，识别ASz的预测因素很重要。本研究的目的是分析大动脉闭塞（LVO）所致缺血性卒中患者群体中ASz的预测因素。
这项回顾性研究检查了2016年至2020年间由LVO引起的急性缺血性卒中患者。使用单因素及随后的多因素逻辑回归分析来识别预测因素。此外，还进行了关于癫痫发作症状学和发作时间（卒中后≤24小时和>24小时）的亚组分析。
979例患者中ASz的发生率为3.9%（n = 38）。单因素逻辑回归分析显示，入院时或入院后24小时美国国立卫生研究院卒中量表（NIHSS）评分较高、入院时高钠血症≥145 mmol/L以及肺炎患者发生ASz的风险增加。进一步的多因素逻辑回归分析显示，入院后24小时的NIHSS是ASz最强的预测因素，尤其是与卒中后24小时后发生的ASz相关。卒中后24小时内发作的患者更易出现全身强直阵挛发作（GTCS）和局灶性运动性发作；超过24小时后，意识障碍发作和非惊厥性癫痫持续状态更为常见。
入院后24小时的NIHSS评分是LVO所致缺血性卒中患者发生ASz的强有力预测因素。ASz的症状学随时间变化，GTCS在卒中后24小时内更频繁出现。
