Frequency, determinants, and effects of early seizures after thrombolysis for acute ischemic stroke: The ENCHANTED trial

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dc.contributor.authorXu, Ying
dc.contributor.authorHackett, Maree
dc.contributor.authorChalmers, John
dc.contributor.authorLindley, Richard
dc.contributor.authorWang, Xia
dc.contributor.authorLi, Qiang
dc.contributor.authorRobinson, Thompson
dc.contributor.authorArima, Hisatomi
dc.contributor.authorLavados, Pablo
dc.contributor.authorAnderson, Craig
dc.contributor.authorFor the ENCHANTED Study Group
dc.date.accessioned2018-01-18T15:36:24Z
dc.date.available2018-01-18T15:36:24Z
dc.date.issued2017
dc.description.abstractBACKGROUND: Seizures after ischemic stroke have not been well-studied. We aim to determine the frequency, determinants, and significance of early seizures after thrombolysis for acute ischemic stroke. METHODS: Data are from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), an international, multicenter, randomized controlled trial where patients with acute ischemic stroke were randomized to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) IV alteplase. The protocol prespecified prospective data collection on in-hospital seizures over 7 days postrandomization. Logistic regression models were used to determine variables associated with seizures and their significance on poor outcomes of death or disability (modified Rankin scale scores 3-6), symptomatic intracerebral hemorrhage (sICH), and European Quality of Life 5-Dimensions questionnaire [EQ-5D] over 90 days. RESULTS: Data were available for 3,139 acute ischemic stroke participants, of whom 42 (1.3%) had seizures at a median 22.7 hours after the onset of symptoms. Baseline variables associated with seizures were male sex (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.07-4.50), severe neurologic impairment (NIH Stroke Scale score ≥10; OR 2.16, 95% CI 1.06-4.40), and fever (OR 4.55, 95% CI 2.37-8.71). Seizures independently predicted poor recovery: death or major disability (OR 2.88, 95% CI 1.28-6.47), unfavorable ordinal shift of mRS scores (OR 1.94, 95% CI 1.10-3.39), and lower than median EQ-5D health utility index score (OR 3.50, 95% CI 1.37-8.91). There was no association of seizures with sICH in adjusted analysis. CONCLUSIONS: In thrombolysis-treated patients with acute ischemic stroke, seizures are uncommon, occur early, and predict poor recovery.
dc.description.versionVersión Publicada
dc.format.extent9
dc.identifier.citationXu Y, Hackett ML, Chalmers J, Lindley RI, Wang X, Li Q, Robinson T, Arima H, Lavados PM, Anderson CS; ENCHANTED Study Group. Frequency, determinants, and effects of early seizures after thrombolysis for acute ischemic stroke: The ENCHANTED trial. Neurol Clin Pract. 2017 Aug;7(4):324-332. doi: 10.1212/CPJ.0000000000000384.
dc.identifier.urihttp://hdl.handle.net/11447/1919
dc.identifier.urihttp://dx.doi.org/10.1212/CPJ.0000000000000384
dc.language.isoen_US
dc.publisherLippincott Williams & Wilkins
dc.sourceNeurology Clinical Practice
dc.subjectAcute ischemic stroke
dc.subjectEarly seizures
dc.subjectThrombolysis
dc.subjectENCHANTED trial
dc.titleFrequency, determinants, and effects of early seizures after thrombolysis for acute ischemic stroke: The ENCHANTED trial
dc.typeArtículo

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