Time from stroke to epilepsy onset may predict risk of drug resistance in post stroke epilepsy

Italy: A new study published in the European Journal of Neurology suggests that significant diversity in the mechanisms or pathways leading to post-stroke epilepsy (PSE), allowing patients with a varying risk of medication resistance.

Because epileptogenesis is progressive, it begs the issue of whether the latent stage contains information about the features of the eventual epilepsy. Simona Lattanzi and colleagues undertook this investigation to see if the duration between stroke and epilepsy start was associated with the likelihood of treatment resistance in individuals with post-stroke epilepsy.

Patients with epilepsy caused by a cerebral infarction or spontaneous intracerebral hemorrhage were included in the study. The lack of adequate trials of two tolerated and adequately chosen and utilized anti-seizure medication regimens to achieve prolonged seizure independence was designated as the study's result.

The key findings of this study were as follows:

1. There were 149 patients with PSE who had a median follow-up of 5 [interquartile range (IQR) 3-9] years.

2. 29 (18.2%) of the patients in the study were medication resistant.

3. The median time delay between stroke and PSE development was 13 [IQR 7-15] months in medication resistant patients and 19 [IQR 14-42] months in seizure control patients.

4. The time from stroke to PSE was an independent predictor of medication resistance, according to multivariable regression analysis.

5. The likelihood of medication resistance was highest when the beginning of PSE occurred during the first months after a stroke, and it gradually declined with a sharper fall over the first 12 months.

This study has a few flaws, including a single-center design, potential bias, misdiagnosis, a lack of data on modifiable variables (e.g., genetics, post-stroke exposures), and uncertain management of acute symptomatic seizures.

In conclusion, the time to commencement of post-stroke epilepsy independently predicted the likelihood of anti-seizure drug resistance, with the highest risk for individuals whose seizures began during the first few months following stroke.

Reference: Lattanzi, S., Trinka, E., Turcato, G., Rinaldi, C., Cagnetti, C., Foschi, N., Broggi, S., Norata, D., Brigo, F. and Silvestrini, M. (2022), The latency of post-stroke epilepsy can predict drug resistance. Eur J Neurol. Accepted Author Manuscript. https://doi.org/10.1111/ene.15408