Epilepsia · 2026
Association of carotid revascularization with epilepsy and seizures in patients with carotid stenosis.
СтатьяНазвание и аннотация: Перевод в очереди
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Chuang Ming-Tsung, Chang Yu, Wong Chia-En, Huang Chih-Yuan, Perng Pang-Shuo
Аннотация
OBJECTIVE: The potential influence of carotid stenosis on seizure or epilepsy outcomes and whether revascularization modifies this risk remain understudied.
METHODS: Using a large real-world database, we identified adults diagnosed with carotid stenosis and excluded those with prior seizures, epilepsy, or common provoking conditions. Patients were classified according to whether they underwent carotid endarterectomy or carotid artery stenting within 1 month of diagnosis. Propensity score matching was performed based on demographic variables and major vascular comorbidities. The primary outcome was a composite of new onset seizures or epilepsy at 1 month, 3 months, and 2 years of follow-up.
RESULTS: Among 848 939 eligible patients, 41 225 were matched. Carotid revascularization was associated with significantly lower risk of seizures or epilepsy. Incidence in the revascularization group was .3% at 1 month, .4% at 3 months, and .8% at 2 years, corresponding to hazard ratios of .30 (95% confidence interval [CI] = .24-.38), .36 (95% CI = .30-.43), and .41 (95% CI = .36-.47), respectively. These associations remained consistent across symptomatic and asymptomatic subgroups and between procedural modalities. In sensitivity analysis including patients who experienced ischemic or hemorrhagic stroke after carotid stenosis diagnosis, seizure or epilepsy incidence remained lower in the revascularization group, with hazard ratios of .27 (95% CI = .18-.41) at 3 months and .35 (95% CI = .28-.45) at 2 years.
SIGNIFICANCE: Beyond its established role in stroke prevention, carotid revascularization was associated with reduced incidence of seizures or epilepsy in this real-world analysis. This association persisted even among patients who experienced cerebrovascular events following the procedure. The potential protective effect of revascularization and its underlying mechanisms warrant further investigation.
METHODS: Using a large real-world database, we identified adults diagnosed with carotid stenosis and excluded those with prior seizures, epilepsy, or common provoking conditions. Patients were classified according to whether they underwent carotid endarterectomy or carotid artery stenting within 1 month of diagnosis. Propensity score matching was performed based on demographic variables and major vascular comorbidities. The primary outcome was a composite of new onset seizures or epilepsy at 1 month, 3 months, and 2 years of follow-up.
RESULTS: Among 848 939 eligible patients, 41 225 were matched. Carotid revascularization was associated with significantly lower risk of seizures or epilepsy. Incidence in the revascularization group was .3% at 1 month, .4% at 3 months, and .8% at 2 years, corresponding to hazard ratios of .30 (95% confidence interval [CI] = .24-.38), .36 (95% CI = .30-.43), and .41 (95% CI = .36-.47), respectively. These associations remained consistent across symptomatic and asymptomatic subgroups and between procedural modalities. In sensitivity analysis including patients who experienced ischemic or hemorrhagic stroke after carotid stenosis diagnosis, seizure or epilepsy incidence remained lower in the revascularization group, with hazard ratios of .27 (95% CI = .18-.41) at 3 months and .35 (95% CI = .28-.45) at 2 years.
SIGNIFICANCE: Beyond its established role in stroke prevention, carotid revascularization was associated with reduced incidence of seizures or epilepsy in this real-world analysis. This association persisted even among patients who experienced cerebrovascular events following the procedure. The potential protective effect of revascularization and its underlying mechanisms warrant further investigation.