Effect of Intravenous Thrombolysis and Mechanical Thrombectomy on the Incidence of Acute Symptomatic Seizure and Post-Stroke Epilepsy in Patients with Acute Large-Vessel Occlusion

• Published in: Journal of Neuroendovascular Therapy Vol. 18; no. 8; pp. 207 - 212
• Main Authors: Ishihara, Hideaki, Kohyama, Shinya, Nishida, Sho, Kumagai, Kosuke, Hayashi, Shinji, Kato, Hiroshi
• Format: Journal Article
• Language: English
• Published: The Japanese Society for Neuroendovascular Therapy 2024
• Subjects: acute symptomatic seizure; large vessel occlusions; mechanical thrombectomy; Original; post-stroke epilepsy
• ISSN: 1882-4072; 2186-2494
• DOI: 10.5797/jnet.oa.2024-0007

Objective: Reperfusion therapy, such as intravenous tissue-plasminogen activator (IV-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke, may increase the incidence of acute symptomatic seizure (ASS) and post-stroke epilepsy (PSE). This study aimed to analyze the effect and predictors of reperfusion therapy for ASS and PSE limited to large-vessel occlusions (LVOs).Methods: This retrospective study classified 237 subjects with LVO into four groups: (1) IV-tPA + MT+ (n = 74 cases, (2) MT only (n = 82), (3) tissue-plasminogen activator (tPA) only (n = 28), and (4) IV-tPA – MT– (n = 53). The incidences of ASS and PSE were assessed. Potential predictors, such as etiology, functional disability, neuroimaging findings, and the SeLECT score, were statistically analyzed.Results: There were 12 (5.1%) subjects with ASS and 10 subjects (4.2%) with PSE. The IV-tPA and MT groups had significantly high reperfusion rates, with a Thrombolysis in Cerebral Infarction score ≥2c (p = 0.01) but there were no significant differences in the increases of hemorrhagic transformation, ASS, and PSE. An Alberta Stroke Program Early Computed Tomography Score <6 was a significant predictor of ASS (p = 0.01), and an infarct volume >60 ml was a significant predictor of PSE (p = 0.01).Conclusion: Reperfusion therapy for acute LVO was not found to increase the risk of ASS and PSE. Large-sized infarctions should be treated with care in PSE.