Lower Epilepsy Risk in Thrombolysis Alone, Combined With Thrombectomy for Ischemic Stroke

Patients with ischemic stroke who receive thrombolysis, with and without thrombectomy, have a decreased risk for epilepsy, and thrombectomy alone is associated only with a lower risk for epilepsy in severe strokes, investigators reported in the Journal of the American Heart Association.

The Danish register-based, propensity score-matched cohort study enrolled patients with an ischemic stroke from January 1, 2011, to December 16, 2018.

The participants were aged 18 years or older, resided in Denmark for 10 years or longer, and had no previous diagnosis of epilepsy or stroke (excluding transient ischemic attack).

Individuals in the 3 treatment groups (thrombolysis, thrombectomy, and thrombolysis and thrombectomy), were matched 1:1 with nontreated patients with stroke. The patients were followed from 14 days after stroke until initial diagnosis of epilepsy, death, emigration, or end of follow-up on December 31, 2018.

Among 40,816 patients who survived the first 14 days poststroke, 6541 were treated with thrombolysis (mean age, 67.7 years; 59.4% men), 1005 received thrombectomy and thrombolysis (mean age, 67.2 years; 57.1% men), and 379 received thrombectomy alone (mean age, 68.8 years; 57.0% men).

The patients had 43,122 person-years of follow-up, in which epilepsy was diagnosed in 3.2% of patients who received thrombolysis alone, 7.3% of patients who received thrombolysis and thrombectomy, 4.7% of patients who received thrombectomy alone, and 5.6% of nontreated matched patients.

Individuals who received thrombolysis alone had a 34% reduced risk for epilepsy vs nontreated matched reference patients (adjusted HR [aHR], 0.68; 95% CI, 0.57-0.81). Treatment for patients with thrombectomy and thrombolysis was associated with a 43% reduced risk for epilepsy vs nontreated matched reference patients (aHR, 0.55; 95% CI, 0.41-0.73). After treatment with thrombectomy alone, the relative risk for epilepsy was not significantly different vs the nontreated matched reference patients (aHR, 0.78; 95% CI, 0.57-1.29).

In patients with mild and moderate stroke, thrombolysis alone was associated with a lower risk for epilepsy (aHR, 0.58 [95% CI, 0.37-0.91]; and aHR, 0.71 [95% CI, 0.56-0.90]; respectively). For individuals with the most severe strokes, thrombolysis alone was not associated with a significant difference in epilepsy risk vs the reference group (aHR, 0.81; 95% CI, 0.52-1.53). In these patients, thrombolysis and thrombectomy (aHR, 0.41; 95% CI, 0.26-0.67) and thrombectomy alone (aHR, 0.35; 95% CI, 0.15-0.83) were associated with a decreased risk for epilepsy vs the reference group.

Among all treatment groups, the lack of improvement in stroke symptoms 24 hours after treatment was associated with a greater risk for epilepsy vs patients who improved by 1 point or more on the National Institutes of Health Stroke Scale score 24 hours after treatment initiation (thrombolysis aHR, 3.11 [95% CI, 2.20-4.33]; thrombectomy aHR, 2.76 [95% CI, 0.81-9.43]; and thrombolysis and thrombectomy aHR, 2.83 [95% CI, 1.48-5.40]).

Limitations of the study include the lack of access to imaging data, the epilepsy diagnoses assigned in the registers were not validated, and the number of revascularized patients treated with thrombectomy alone was relatively low.

“The findings support acute management of ischemic stroke and the beneficial effect of these revascularization treatments on morbidity and death,” the investigators wrote.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor