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    Association between different acute stroke therapies and development of post stroke seizures

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    Author
    Naylor, J; Thevathasan, A; Churilov, L; Guo, R; Xiong, Y; Koome, M; Chen, Z; Chen, Z; Liu, X; Kwan, P; ...
    Date
    2018-05-03
    Source Title
    BMC Neurology
    Publisher
    BIOMED CENTRAL LTD
    University of Melbourne Author/s
    Churilov, Leonid; Naylor, Jillian; Kwan, Patrick; Campbell, Bruce
    Affiliation
    Medicine and Radiology
    Metadata
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    Document Type
    Journal Article
    Citations
    Naylor, J., Thevathasan, A., Churilov, L., Guo, R., Xiong, Y., Koome, M., Chen, Z., Chen, Z., Liu, X., Kwan, P. & Campbell, B. C. V. (2018). Association between different acute stroke therapies and development of post stroke seizures. BMC NEUROLOGY, 18 (1), https://doi.org/10.1186/s12883-018-1064-x.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/255022
    DOI
    10.1186/s12883-018-1064-x
    Abstract
    BACKGROUND: Epilepsy is a major complication of stroke. We aimed to establish whether there is an association between intravenous thrombolysis, intra-arterial thrombolysis and post stroke seizure (PSS) development. Improved understanding of the relationship between reperfusion therapies and seizure development may improve post-stroke monitoring and follow-up. METHODS: This was a retrospective, multicentre cohort study conducted at the Royal Melbourne Hospital and Jingling Hospital Nanjing. We included patients with anterior circulation ischemic stroke admitted 2008-2015. Patients were divided into four treatment groups 1. IV-tPA only, 2. Intra-arterial therapies (IAT) only, 3. IAT + IV-tPA and 4. stroke unit care only (i.e. no IV-tPA or IAT). To assess the association between type of reperfusion treatment and seizure incidence we used multivariable logistic regression models adjusted for age, stroke severity, 3-month functional outcome and prognostic factors. RESULTS: There were 1375 stroke unit care-only patients, of whom 28 (2%) developed PSS. There were 363 patients who received only IV-tPA, of whom 21 (5.8%) developed PSS. There were 93 patients who received IAT only, of whom 12 (12.9%) developed PSS and 112 that received both IV-tPA + IAT, of which 5 (4.5%) developed PSS. All reperfusion treatments were associated with seizure development compared to stroke unit care-only patients: IV-tPA only adjusted odds ratio (aOR) 3.7, 95%CI 1.8-7.4, p < 0.0001; IAT aOR 5.5, 95%CI 2.1-14.3, p < 0.0001, IAT + IV-tPA aOR 3.4, 95% CI 0.98-11.8, p = 0.05. These aORs did not differ significantly between treatment groups (IV-tPA + IAT versus IV-tPA p = 0.89, IV-tPA + IAT versus IAT, p = 0.44). CONCLUSIONS: Patients receiving thrombolytic or intra-arterial reperfusion therapies for acute ischemic stroke are at higher risk of epilepsy and may benefit from longer follow-up. No evidence for an additive or synergistic effect of treatment modality on seizure development was found.

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