Table 2 Studies reporting risk factors for post-stroke seizures after thrombolysis or mechanical thrombectomy

Alemany et al. [51]

mechanical thrombectomy; ASS and PSE

344 patients with ischaemic stroke and NIHSS > 8 treated with thrombectomy

21 (6.1%) presented ASS, The accumulated PSE incidence at 5 years was 8.93%; rt-PA not an independent risk factor for ASS

for ASS: degree of reperfusion: OR 2.02

1 centre, retrospective, observation period > / = 5 years

Alvarez et al. [48]

rt-PA and PSS prognosis

28 of 2,327 patients had PSS (1.2%)

Worse outcome in rt-PA and PSS versus rt-PA without PSS

for ASS: Cortical involvement: OR 7.5, rt-PA: OR 4.6

PSS < 7 days, mostly < 72 h, 1 centre, 3-month period

Bentes et al. [49]

rt-PA versus no thrombolysis

101 patients rt-PA; 50 no rt-PA

Seizure symptoms during rt-PA infusion 5% (p = 0.726 and p = 0.4); no difference in seizure frequency with/without rt-PA

–

Observation period 1 year, 1 centre

Brigo et al. [52]

rt-PA effect on seizure development < 7 days

79 patients

rt-PA OR 2.26

for ASS: Cortical localization: OR 2.49; i.v. rt-PA: OR: 2.26

1 centre, period: weeks

Brondani et al. [56]

rt-PA, PSE influence on prognosis

153 patients, rt-PA 13 patients

7% PSS, 9% PSE

for PSE: hemorrhagic transformation: OR = 3.55, mRS > / = 2 at 3 months after stroke: OR: 5.82

1 centre, observation period at least 2 years

Castro-Apolo et al. [55]

rt-PA versus no thrombolysis

42 patients with seizures, 62 without

33 early seizures, late seizures in 66.7%; no association with rt-PA (p = 0.25)

PSE worsens outcome

1 centre, mean observation period 20 months

De Reuck et al. [62]

rt-PA versus anticoagulant

38 patients rt-PA

269 patients OAC

769 patients antithrombotic

ASS increase as a correlate of reperfusion, partial reduction of late seizures

ASS associated with stroke severity

Cardiogenic or atherothrombotic ischaemic stroke only, 1 centre

Gasparini et al. [59]

rt-PA versus mechanical thrombectomy

26,055 patients (meta-analysis)

1800 (7%) PSE

for PSE: Cortical lesions: OR 3.58, hemorrhagic component: OR: 2.47, ASS: OR: 4.88, younger age at stroke onset (difference in means: 2.97 years)

Multicentre meta-analysis

Heterogeneous time periods

Keller et al. [60]

rt-PA versus no thrombolysis; PSE

302 patients

PSE incidence: 20.6% rt-PA versus 10.7% no rt-PA; no effect of rt-PA after adjustment for other variables

for PSE: low Barthel Index at discharge; hemianopia; infection acquired during the hospital stay; involvement of the temporal lobe; involvement of the perirolandic cortex

1 centre, 42-month period (max. 80 months)

Lekoubou et al. [57]

rt-PA versus mechanical thrombectomy; PSS

13,753 patients (meta-analysis)

529 PSS with rt-PA (6.1%), PSE 6.7%, ASS 3.14%

Pooled OR: rt-RA und PSS 1.24 (not significant), no difference PSE regarding rt-PA or mechanical thrombectomy

multicentre meta-analysis

Naylor [54]

rt-PA versus IAT versus IAT + rt-PA (PSS)

363patients rt-PA: PSE 5.8%

1375 patients, stroke unit only

PSS: IAT 12.9%

rt-PA + IAT 4.5%

2% PSE

for PSE

rt-PA: OR 3.7

IAT: OR 5.5

rt-PA + IAT: OR 3.4

multicentric, 2-year period

Nesselroth et al. [63]

rt-PA versus antiaggregation

rt-PA 141 patients

rt-PA + antiaggregation 141 patients

antiaggregation only 95 patients

PSS: rt-PA 8.1%

antiaggregation 12.6%

rt-PA + antiaggregation 5.8%

rt-PA reduces PSS risk by 6%

1 centre, 1-year period

Tan et al. [65]

rt-PA versus no thrombolysis

177 patients rt-PA

158 patients no rt-PA

PSE: 8.25% rt-PA, no rt-PA 6.5%; no significant effect of rt-PA on PSE risk

PSE worsens functional prognosis

2-year period with phone interview, 1 centre

Polymeris et al. [119]

presence of ASS

10,074 patients rt-PA

1.5% ASS

seizures at onset not an independent predictor of outcome

Pooled data from 9 centres

rt-PA with or without subsequent endovascular therapy

Multicentre

Various time periods

Zöllner et al. [61]

rt-PA versus mechanical thrombectomy; ASS

13,356 patients with rt-PA and 1013 patients with rt-PA and mechanical thrombectomy

ASS: 1.5% (n = 199) with rt-PA versus 1.8% (n = 237) in controls without rt-PA

1.7% with rt-PA and mechanical thrombectomy versus 1.7% (each n = 17) in controls with rt-PA only

No difference in frequency of ASS between patients with rt-PA versus no recanalisation (historical cohort) or rt-PA and mechanical thrombectomy versus rt-PA only

Study matched for age, NIHSS and premorbid function level with population-based register data