Code Stroke System Reduces Post-Stroke Epilepsy Risk in Older Adults

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All patients received IV thrombolysis at admission and were evaluated for epilepsy at up to 2 years or until death.
All patients received IV thrombolysis at admission and were evaluated for epilepsy at up to 2 years or until death.

The code stroke system, which consists of rapid clinical assessment, revascularization, and harmonization of hemodynamic and metabolic disturbances, lowers the risk for poststroke epilepsy in patients receiving intravenous thrombolysis for acute ischemic stroke, according to a retrospective study published in Neurology.

An ongoing stroke database was used to collect information about consecutive patients who were admitted to the hospital with acute stroke. In this retrospective analysis, investigators enrolled a total of 409 patients with a median age at stroke onset of 75 years (interquartile range 64-83 years). All patients received intravenous thrombolysis at admission and were evaluated for epilepsy at up to 2 years or until death.

During the median follow-up of 1074 days (interquartile range 119-1671 days), a total of 32 patients (7.8%) experienced poststroke seizures. These seizures consisted of acute symptomatic seizures (1.7%) and late-onset seizures (6.1%). Poststroke epilepsy occurred in 26 patients (6.4%) during follow-up. Younger age was found to be significantly associated with poststroke epilepsy (P <.001).

The code stroke system was implemented in 318 patients (77.8%) vs 91 patients (22.2%) who did not receive the code stroke treatment. Patients treated with the code stroke system had significantly lower odds of having poststroke epilepsy compared with patients who were not treated with the system after adjustment for stroke etiology and age (odds ratio 0.36; 95% CI, 0.14-0.87, P =.024). The adjusted analysis also demonstrated that the code stroke system was associated with a decreased risk for poststroke epilepsy within 5 years of stroke (hazard ratio 0.60; 95% CI, 0.47-0.79, P <.001).

A small proportion of patients in this study received intraarterial treatment; however, the investigators were unable to determine the effect of endovascular thrombectomy on poststroke seizure risk and its ultimate influence on the code stroke system. Questionnaires were also used to determine poststroke seizure occurrence, even though the use of questionnaires may lead to misdiagnosis during long-term follow-up.

Further research “should investigate whether posttreatment factors, such as stroke volume after thrombolysis, cortical involvement, or functional outcome differ between those allocated to code stroke vs controls” to understand the precise mechanisms of the code stroke system that drive the reduced epilepsy risk.

Reference

Chen Z, Churilov L, Chen Z, et al. Association between implementation of a code stroke system and poststroke epilepsy. Neurology. 2018;90(13):e1126-e1133.

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