Abstract Details

Title Mortality and functional outcomes in patients with post-stroke epileptic seizures: a systematic review and meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S45 - Cerebrovascular Disease and Interventional Neurology: Meta-analyses and Outcomes Research (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Background It is critical to highlight the burden of PSE on patient outcomes. Whereas PSE has been reported to worsen outcomes in stroke patients, published data are inconclusive.

Objective To conduct a meta-analysis of published data to comprehensively investigate clinical and functional outcomes in post-stroke epilepsy (PSE) patients.

Design/Methods We used Covidence to conduct a literature search of studies published until 1-March-2022. We used Joanna Briggs Institute tool for cohort studies to assess the risk of bias. Our outcome measures include mortality and poor outcomes (Rankin Scale score 3-6). We report Odds ratio (OR) and 95% Confidence Intervals (CI) using a random-effect meta-analysis. Publication bias was assessed using Egger’s test. We conducted the statistical analyses in R version 4.2.0. (PROSPERO ID: CRD42022308648)

Results

We screened 3721 studies and included 71 articles (N= 29,759 patients with PSE; 17,42,083 patients without PSE). Articles reported 3938 early and 13,067 late seizures; 12,754 seizures were not classified as early/late. Risk of bias was high in two studies, moderate in 36 and low in 33. PSE was associated with greater odds of mortality (OR 2.09; CI 1.78-2.45; N= 52 studies) and poor outcomes (OR 2.39; CI 1.91-3.00; N= 19 studies). In subgroup analyses, post-ischemic stroke epilepsy was associated with mortality (OR 2.31; CI 1.88-2.83) and poor outcome (OR 2.60; CI 1.91-3.52). Post-hemorrhagic stroke epilepsy showed consistently significant OR for the poor outcome (OR 2.04; CI 1.33-3.13) but failed to reach statistical significance for mortality (OR 1.29; CI 0.96-1.74). No significant publication bias was observed for mortality (p=0.93) and poor outcome (p=0.17).

Conclusions Our meta-analysis suggests that PSE is associated with a doubled risk of death and severe disability. Prevention of PSE should be a high research priority. The role of stroke severity or lesion volume also requires further study.

Authors/Disclosures
Shubham Misra, PhD (Yale University) PRESENTER	Dr. Misra has nothing to disclose.
Juan P. Vazquez (Albert Einstein College of Medicine)	Juan Vazquez, MD has nothing to disclose.
Ece Eldem, MSc	Ms. Eldem has nothing to disclose.
Lucas S. Silva, MD (University of Campinas)	Dr. Silva has nothing to disclose.
Saba S. Mohidat, Jr., MD	Dr. Mohadat has nothing to disclose.
Leonard B. Hickman, MD (UCLA)	Dr. Hickman has nothing to disclose.
Erum Khan (B.J.Medical College,Ahmedabad)	Ms. Khan has nothing to disclose.
Melissa Funaro (Yale)	No disclosure on file
Clarissa L. Yasuda, MD, PhD (University of Campinas)	Prof. Yasuda has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for LIBBS. Prof. Yasuda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ABBOTT. Prof. Yasuda has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for LIBBS.
David S. Liebeskind, MD, FAAN (Neurovascular Imaging Research Core at UCLA)	Dr. Liebeskind has received research support from Cerenovus. Dr. Liebeskind has received research support from Genentech . Dr. Liebeskind has received research support from Medtronic. Dr. Liebeskind has received research support from Stryker.
Scott E. Kasner, MD, FAAN (University of Pennsylvania)	Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol-Myers Squibb. Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Diamedica. Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca. Dr. Kasner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Javelin. Dr. Kasner has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for UpToDate. The institution of Dr. Kasner has received research support from Bristol-Myers Squibb. The institution of Dr. Kasner has received research support from Medtronic. The institution of Dr. Kasner has received research support from WL Gore.
Nishant K. Mishra, MD, MBBS, PhD, FESO (Yale University)	Dr. Mishra has nothing to disclose.