Outcomes in Patients With Poststroke Seizures: A Systematic Review and Meta-Analysis.

Autor:	Misra S; Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut., Kasner SE; The University of Pennsylvania, Philadelphia., Dawson J; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom., Tanaka T; Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan., Zhao Y; Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut., Zaveri HP; Department of Neurology, Yale University School of Medicine, New Haven, Connecticut., Eldem E; Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut., Vazquez J; Albert Einstein College of Medicine, Bronx, New York., Silva LS; Department of Neurology, School of Medical Sciences, University of Campinas-UNICAMP, Sao Paulo, Brazil., Mohidat S; The University of Melbourne, Melbourne, Victoria, Australia., Hickman LB; Department of Neurology, The University of California, Los Angeles., Khan EI; Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.; Alzheimer's Disease Research Center, University of Alabama, Birmingham., Funaro MC; Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut., Nicolo JP; Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Monash University, Melbourne, Victoria, Australia., Mazumder R; Department of Neurology, The University of California, Los Angeles., Yasuda CL; Department of Neurology, School of Medical Sciences, University of Campinas-UNICAMP, Sao Paulo, Brazil., Sunnerhagen KS; Department of Clinical Neuroscience, University of Gothenburg, Göteborg, Sweden., Ihara M; Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan., Ross JS; Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut., Liebeskind DS; Department of Neurology, The University of California, Los Angeles., Kwan P; The AIM for Health, Faculty of IT, Monash University, Melbourne, Victoria, Australia., Quinn TJ; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom., Engel J Jr; Department of Neurology, The University of California, Los Angeles., Mishra NK; Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.
Jazyk:	angličtina
Zdroj:	JAMA neurology [JAMA Neurol] 2023 Nov 01; Vol. 80 (11), pp. 1155-1165.
DOI:	10.1001/jamaneurol.2023.3240
Abstrakt:	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.
Databáze:	MEDLINE
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