title: Does treatment with t-PA increase the risk of developing epilepsy after stroke?
abstract: Patients suffering from ischemic stroke carry an enhanced risk of developing secondary epilepsy. We sought to clarify whether thrombolytic treatment with recombinant tissue plasminogen activator (t-PA) is independently associated with post-stroke epilepsy (PSE). In this observational study, data from 302 stroke patients treated at a single academic neurological department were analyzed retrospectively. Median follow-up was 42 months (maximum 80). Variables included presence of comorbidity, stroke severity, neurological presentation, complications, infarct characteristics, and treatment with t-PA. After univariate analyses, a multivariate analysis was performed to create a model of factors that were significantly associated with PSE, including treatment with t-PA. 13.9 % of patients developed PSE during follow-up. Multivariate analysis identified 5 independent factors for PSE: low Barthel Index at discharge; hemianopia; infection acquired during the hospital stay; involvement of the temporal lobe; involvement of the perirolandic cortex. While the incidence of PSE was higher in patients treated with t-PA (20.6 vs. 10.7 %, univariate analysis; p = 0.020), the effect was lost after adjusting for several factors associated with t-PA treatment [odds ratio for PSE after treatment with t-PA 1.3 (95 % CI 0.6-2.9), p = 0.489]. This study failed to identify treatment with t-PA as an independent risk factor for PSE.
authors.affiliation: Department of Neurology, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Keller
authors.affiliation: Department of Neurology, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Hobohm
authors.affiliation: Department of Neurology, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.|Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Leipzig, Germany.
authors.forename: Samira
authors.initials: S
authors.lastname: Zeynalova
authors.affiliation: Department of Neurology, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
authors.forename: Joseph
authors.initials: J
authors.lastname: Classen
authors.affiliation: Department of Neurology, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. petra.baum@medizin.uni-leipzig.de.
authors.forename: Petra
authors.initials: P
authors.lastname: Baum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D004827:Epilepsy / Q000139:chemically induced*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Cerebral ischemia; Epilepsy; Observational study; Stroke; Thrombolysis; t-PA (tissue plasminogen activator)