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

From: Seizures and epilepsy in patients with ischaemic stroke

Author Research subject Patients Results Risk factors (independent) Method characteristics
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
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
  1. Studies of risk factors for seizure development following thrombolysis. aOR: adjusted odds ratio, ASS: acute symptomatic seizures, IAT, intra-arterial therapy, NIHSS: National Institutes of Health Stroke Scale, OAC: oral anticoagulant, OR: odds ratio, PSE: post-stroke epilepsy, PSS: post-stroke epileptic seizure, rt-PA: recombinant plasminogen activator