Advancing Toward a World Without Vision Loss From Diabetes: Insights From The Mary Tyler Moore Vision Initiative Symposium 2024 on Curing Vision Loss From Diabetes.
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Sinka Lucia, Abraira Laura, Imbach Lukas L, Zieglgänsberger Dominik, Santamarina Estevo, Álvarez-Sabín José, Ferreira-Atuesta Carolina, Katan Mira, Scherrer Natalie, Bicciato Giulio, Terziev Robert, Simmen Cyril, Schubert Kai Michael, Elshahabi Adham, Baumann Christian R, Döhler Nico, Erdélyi-Canavese Barbara, Felbecker Ansgar, Siebel Philip, Winklehner Michael, von Oertzen Tim J, Wagner Judith N, Gigli Gian Luigi, Serafini Anna, Nilo Annacarmen, Janes Francesco, Merlino Giovanni, Valente Mariarosaria, Zafra-Sierra María Paula, Bayona-Ortiz Hernan, Conrad Julian, Evers Stefan, Lochner Piergiorgio, Roell Frauke, Brigo Francesco, Bentes Carla, Peralta Ana Rita, Pinho E Melo Teresa, Keezer Mark R, Duncan John S, Sander Josemir W, Tettenborn Barbara, Koepp Matthias J, Galovic Marian
Аннотация
OBJECTIVE: To compare mortality and risk of epilepsy following different types of acute symptomatic seizures.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022.
EXPOSURES: Type of acute symptomatic seizure.
MAIN OUTCOMES AND MEASURES: All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke).
RESULTS: A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy.
CONCLUSIONS AND RELEVANCE: In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up.