Highlights
- •Use of IV-tPA was associated with hospital revisit for PISE when adjusting for demographics, comorbidities, and characteristics of the index stroke admission.
- •There was no independent association between MT and PISE-related revisits in adjusted models.
- •Decompressive craniectomy was associated with more than a 2-fold increase in the risk for revisit for PISE.
- •The occurrence of in-hospital seizures correlated most closely with long-term revisits for PISE.
Abstract
Objectives
Improvements in acute stroke care have led to an increase in ischemic stroke survivors,
who are at risk for development of post-ischemic stroke epilepsy (PISE). The impact
of therapies such as thrombectomy and thrombolysis on risk of hospital revisits for
PISE is unclear. We utilized administrative data to investigate the association between
stroke treatment and PISE-related visits.
Materials and methods
Using claims data from California, New York, and Florida, we performed a retrospective
analysis of adult survivors of acute ischemic strokes. Patients with history of epilepsy,
trauma, infections, or tumors were excluded. Included patients were followed for a
primary outcome of revisits for seizures or epilepsy. Cox proportional hazards regression
was used to identify covariates associated with PISE.
Results
In 595,545 included patients (median age 74 [IQR 21], 52% female), the 6-year cumulative
rate of PISE-related revisit was 2.20% (95% CI 2.16-2.24). In multivariable models
adjusting for demographics, comorbidities, and indicators of stroke severity, IV-tPA
(HR 1.42, 95% CI 1.31-1.54, p<0.001) but not MT (HR 1.62, 95% CI 0.90-1.50, p=0.2)
was associated with PISE-related revisit. Patients who underwent decompressive craniectomy
experienced a 2-fold increase in odds for returning with PISE (HR 2.35, 95% CI 1.69-3.26,
p<0.001). In-hospital seizures (HR 4.06, 95% CI 3.76-4.39, p<0.001) also elevated
risk for PISE.
Significance
We demonstrate that ischemic stroke survivors who received IV-tPA, underwent decompressive
craniectomy, or experienced acute seizures were at increased risk PISE-related revisit.
Close attention should be paid to these patients with increased potential for long-term
development of and re-hospitalization for PISE.
Key Words
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Article info
Publication history
Published online: October 21, 2021
Accepted:
October 2,
2021
Received in revised form:
September 28,
2021
Received:
July 9,
2021
Footnotes
The present manuscript was completed within the Department of Neurology at Yale School of Medicine in New Haven, CT. The manuscript complies with all instructions to authors. All authors have met authorship requirements and provided final approval of the manuscript. The manuscript has not previously been published and is not under consideration for publication by another journal. Given that only de-identified subject data from publicly available databases were used, this study was exempt from review from our institutional review board. The STROBE checklist was used for this study.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106155
Copyright
© 2021 Elsevier Inc. All rights reserved.
