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- Title
Outcomes in Patients With Poststroke Seizures: A Systematic Review and Meta-Analysis.
- Authors
Misra, Shubham; Kasner, Scott E.; Dawson, Jesse; Tanaka, Tomotaka; Zhao, Yize; Zaveri, Hitten P.; Eldem, Ece; Vazquez, Juan; Silva, Lucas Scárdua; Mohidat, Saba; Hickman, L. Brian; Khan, Erum I.; Funaro, Melissa C.; Nicolo, John-Paul; Mazumder, Rajarshi; Yasuda, Clarissa Lin; Sunnerhagen, Katharina S.; Ihara, Masafumi; Ross, Joseph S.; Liebeskind, David S.
- Abstract
This systematic review and meta-analysis investigates the association of mortality, poor functional outcomes, recurrent stroke, and dementia in patients with poststroke seizures compared with patients without poststroke seizures. Key Points: Question: Are patients with poststroke seizures (PSSs) at a greater risk of mortality, poor functional outcomes, recurrent stroke, and dementia compared with patients without PSSs? Findings: This systematic review and meta-analysis of 71 studies and 20 110 patients with PSS suggests that PSSs are associated with increased mortality risk, poor functional outcomes, disability, and dementia. This study also identifies limitations in existing PSS research, eg, the lack of common data elements, definitions of relevant outcomes, and reporting standards. Meaning: The findings highlight that PSSs are a public health concern and warrant significant research efforts to prevent poststroke epileptogenesis. Importance: Published data about the impact of poststroke seizures (PSSs) on the outcomes of patients with stroke are inconsistent and have not been systematically evaluated, to the authors' knowledge. Objective: To investigate outcomes in people with PSS compared with people without PSS. Data Sources: MEDLINE, Embase, PsycInfo, Cochrane, LILACS, LIPECS, and Web of Science, with years searched from 1951 to January 30, 2023. Study Selection: Observational studies that reported PSS outcomes. Data Extraction and Synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for abstracting data, and the Joanna Briggs Institute tool was used for risk-of-bias assessment. Data were reported as odds ratio (OR) and standardized mean difference (SMD) with a 95% CI using a random-effects meta-analysis. Publication bias was assessed using funnel plots and the Egger test. Outlier and meta-regression analyses were performed to explore the source of heterogeneity. Data were analyzed from November 2022 to January 2023. Main Outcomes and Measures: Measured outcomes were mortality, poor functional outcome (modified Rankin scale [mRS] score 3-6), disability (mean mRS score), recurrent stroke, and dementia at patient follow-up. Results: The search yielded 71 eligible articles, including 20 110 patients with PSS and 1 166 085 patients without PSS. Of the participants with PSS, 1967 (9.8%) had early seizures, and 10 605 (52.7%) had late seizures. The risk of bias was high in 5 studies (7.0%), moderate in 35 (49.3%), and low in 31 (43.7%). PSSs were associated with mortality risk (OR, 2.1; 95% CI, 1.8-2.4), poor functional outcome (OR, 2.2; 95% CI, 1.8-2.8), greater disability (SMD, 0.6; 95% CI, 0.4-0.7), and increased dementia risk (OR, 3.1; 95% CI, 1.3-7.7) compared with patients without PSS. In subgroup analyses, early seizures but not late seizures were associated with mortality (OR, 2.4; 95% CI, 1.9-2.9 vs OR, 1.2; 95% CI, 0.8-2.0) and both ischemic and hemorrhagic stroke subtypes were associated with mortality (OR, 2.2; 95% CI, 1.8-2.7 vs OR, 1.4; 95% CI, 1.0-1.8). In addition, early and late seizures (OR, 2.4; 95% CI, 1.6-3.4 vs OR, 2.7; 95% CI, 1.8-4.1) and stroke subtypes were associated with poor outcomes (OR, 2.6; 95% CI, 1.9-3.7 vs OR, 1.9; 95% CI, 1.0-3.6). Conclusions and Relevance: Results of this systematic review and meta-analysis suggest that PSSs were associated with significantly increased mortality and severe disability in patients with history of stroke. Unraveling these associations is a high clinical and research priority. Trials of interventions to prevent seizures may be warranted.
- Publication
JAMA Neurology, 2023, Vol 80, Issue 11, p1155
- ISSN
2168-6149
- Publication type
Article
- DOI
10.1001/jamaneurol.2023.3240