ACUTE SYMPTOMATIC EPILEPTIC SEIZURES IN PATIENTS WITH IMPAIRED CEREBRAL CIRCULATION
- Authors: Ayubova L.R.1, Kaliushko A.V.1
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Affiliations:
- Voronezh State Medical University named after N. N. Burdenko
- Issue: Vol 10 (2021): Материалы XVII Международной Бурденковской научной конференции 22-24 апреля 2021 года
- Pages: 253-256
- Section: Неврология
- URL: https://new.vestnik-surgery.com/index.php/2415-7805/article/view/6470
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Abstract
Background: Epileptic seizures arise from a 3.0—13.8% of patients with recent acute violation of cerebral circulation. In patients over 60 years of age, stroke is the most common cause of seizures.[1] The relevance of this issue is directly related to mortality among patients who have symptomatic seizures in the acute period of stroke. It was noted that the mortality rate among them is 3 to 10 times higher compared to patients with unprovoked seizures. [2]
Objective: to study the EEG manifestations of acute symptomatic convulsive seizures in patients with acute cerebrovascular accident in the acute period; to study the influence of various factors on the occurrence of seizures and to determine the prognosis.
Materials and methods: analysis of medical records, systematization and grouping of the information received, calculation of the percentage ratio in each study group.
Results: All patients, depending on the changes in the EEG, were divided into 4 groups: with detected epileptiform activity, with the presence of slow-wave activity, with a combination of slowing and epileptiform activity, without pathological changes in the EEG. Within each group, subgroups are identified by age, gender, stroke subtype, and the pool of affected arteries. The analysis of cases of favorable and unfavorable outcomes was also carried out. Most often, fatal cases were observed when the localization of epileptiform activity and deceleration coincided, when the localization of the focus of ischemia and slow-wave activity coincided, with diffuse deceleration, as well as when the focus of ischemia and the localization of epileptiform activity coincided.
Conclusion:In patients with impaired cerebral circulation, acute symptomatic epileptic seizures with EEG registration of epileptiform activity in combination with a slowdown or the presence of only epileptiform activity have a high percentage of mortality and are an unfavorable sign.
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Relevance:
The frequency of acute symptomatic epileptic seizures and the percentage of mortality in their development differs slightly from those in epilepsy, which emphasizes the importance of this topic. [3] Symptomatic epileptic seizures are one of the risk factors for the development of epilepsy, but they are not such due to the presence of a specific cause, whether it is ischemic damage in the brain or a violation of metabolic homeostasis, while epilepsy is characterized by the absence of provoking factors and the recurrence of seizures in the future.
Objective: to analyze the lethality of groups united by various factors affecting the occurrence and frequency of acute symptomatic convulsive seizures in patients with acute cerebrovascular accident, to study the structure of each analyzed group.
Materials and methods:
Our study was conducted on the basis of the analysis of the medical records of patients who had suffered an acute cerebral circulatory disorder with the development of symptomatic convulsive attacks in the acute period and were treated in the neurological department for patients with cerebral circulatory disorders in VOKB No. 1 for the period of 2019. The study and structuring of the case history materials were carried out in the period from September 2020 to February 2021.
A total of 39 case histories were analyzed. The information for the analysis was obtained by studying in each case the medical history of the disease, the examination data, the conclusions of the epileptologist, the conclusions on electroencephalography and computed tomography of the brain. All the subjects underwent X-ray computed tomography of the brain with the ToshibaAquilion 64 device and electroencephalography. The number of males was 21 (53.8%), and the number of females was 18 (46.2%). Among them, 34 people (87.2%) had an ischemic stroke, and 5 people (12.8%) had a hemorrhagic stroke. The age range was from 46 years to 91 years.
Results and discussion:
The average age of the patients with ischemic stroke was 66.9 years, the age range is from 46 to 91 years. The number of fatal cases is 18 (53%). The number of repeated strokes is 8 (23.5%). Among patients with ischemic stroke, there are 13 cases (38.2%) with cardioembolic subtype, 14 cases (41.2%) of unspecified subtype, 5 patients (14.7 %) with atherothrombotic subtype and 2 cases (5.9%) of lacunar subtype. The analysis of arterial pool lesions among cases of circulatory disorders of the ischemic type was carried out. 13 patients (38.2 per cent) there is loss of the left middle cerebral artery in 11 (32.4%) with right middle cerebral artery in 4 patients (11.8 per cent)- the vertebral-basilar basin, in 4 patients (11.8 per cent), there is a combined lesion of the right middle cerebral artery and the vertebral-basilar basin, one patient (3%) revealed the defeat of the left anterior cerebral artery and in one case (3%) of the left posterior cerebral artery.
The average age of patients with hemorrhagic stroke was 64.4 years. The age range is from 55 to 78 years. The number of fatal cases is 3 (60%). The number of repeated strokes is 2 (40%). In three people (60%), the focus is located in the right hemisphere, in the left - in one subject (20%). Also, in one case (20%), a hemorrhagic stroke is noted, according to the type of intraventricular subarachnoid hemorrhage.
All patients were divided into 4 groups depending on the changes in the EEG. The first group includes the subjects with epileptiform activity detected on the EEG and consists of 9 people (23.1%). Of these, 3 were men (33.3%), 6 were women (66.7%). The age range of this group is 55-84 years, the average age in the group is 63.9. In 11.1% of cases (1 person), ischemic changes were observed in hemorrhagic type, in 88.9% of cases (8 people) – in ischemic type. The subtypes of the latter were distributed as follows: cardioembolic - 2 people (25%), atherothrombotic - 3 people (37.5%), unspecified subtype - 3 people (37.5%). Damage to the right medial cerebral artery basin was detected in 2 cases (25%), left medial cerebral artery – 3 cases (37.5%), vertebro - basilar basin in 2 subjects (25%), combined damage to the vertebro-basilar basin and the right medial cerebral artery was present in 12.5% of cases (1 person).
In the subgroup of patients with a favorable outcome (33.3%), the coincidence of the focus of ischemia and the localization of epileptiform activity (left hemisphere) was observed in one case (33.3%). 66.7% (2 subjects) had ischemic lesion of the right hemisphere with generalized epileptiform activity.
The number of fatal cases is 6 (66.7%). Of these, the focus of ischemia and the localization of epileptiform activity coincide in two subjects (33.3%) (in both cases, on the right). Among the rest, the results were distributed differently: in 1 case (16.7%), generalized epileptiform activity and the focus of ischemia on the left are recorded, in the other (16.7%), the focus of ischemia is located on the right and generalized epileptiform activity is recorded. In one person (16.7%), the focus of ischemia is located in both hemispheres of the cerebellum, and the localization of epileptiform activity is on the left. Another study subject (16.7%) had generalized epileptiform activity in both hemispheres and the brain stem, the left hemisphere of the cerebellum, against the background of ischemia.
The second group includes the subjects with the presence of slow-wave activity on the EEG and is 7 people (17.9%). Of these, 2 were women (28.6%) and 5 were men (71.4%). The age range of this group is 49-83 years, the average age in the group is 69.6. In 14.3% of cases (1 person), circulatory disorders developed by hemorrhagic type, in 85.7% of cases (6 people) – by ischemic type. Subtypes of ischemic stroke were distributed as follows: cardioembolic in one patient (16.7%), atherothrombotic – 2 cases (33.3%), lacunar – one case (16.7%), unspecified subtype in 33.3% of cases (2 people). The damage to the arterial pools in the case of ischemic stroke is 66.7% in the case of damage to the right middle cerebral artery (4 cases), the left middle cerebral artery -16.7% (1 case), the vertebrobasillary pool in combination with the right middle cerebral artery 16.7% of cases (1 person).
In the study of cases with a favorable outcome (3 cases; 42.9%), the results were distributed as follows: in one case (33.3%), generalized deceleration developed with circulatory disorders in the right hemisphere, in the other – in the left hemisphere (33.3%). In one subject (33.3%), the ischemic zone is located in the left hemisphere and the EEG shows a focal deceleration of the central-parietal-temporal regions on the left.
The proportion of cases of an unfavorable outcome in this group was 57.1% (4 people). Among them, the coincidence of the localization of the focus of ischemia and slow-wave activity was noted in 2 cases (50%) and was localized in the right hemisphere. Diffuse deceleration with impaired cerebral circulation in the right hemisphere is 50% (2 subjects).
The third group includes subjects with a combination of slowing and epileptiform activity on the EEG and is 15 people (38.5%). Of these, 9 were women (60%) and 6 were men (40%). The age range of this group is 46-91 years, the average age in the group is 69.7. The number of deaths is 8 (53.3%). The proportion of patients with hemorrhagic stroke was 13.3% (2 cases), with ischemic stroke-86.7% (13 cases). The ratio of subtypes of ischemic stroke was as follows: cardioembolic-5 cases (38.5%), unspecified – 6 cases (46.2%), atherothrombotic – 1 case (7.7%), lacunar-1 case (7.7%). The lesion of the left middle cerebral artery basin was observed in 5 cases (38.5%), the right middle cerebral artery-in 4 cases (30.8%), the vertebrobasilar basin-in two cases (15.4%), and the left posterior cerebral artery-in one case (7.7%). A combined lesion of the vertebrobasilar basin and the right medial cerebral artery was observed in one case (7.7%)
Among the cases with a fatal outcome were obtained the following results: in four cases (50%) there is a convergence of the localization of epileptiform activity and deceleration, in two cases (25%) match the focus of stroke and localization of slowing down, in one case (12.5 percent) coincide the center of stroke, localization slowing down and epileptiform activity, in the same case as the localization of epileptiform activity and the source of the stroke.
Among the cases with a favorable outcome, the results are as follows: in three cases (42.9%), the localization of epileptiform activity and deceleration coincide, in three cases (42.9%), the focus of stroke and the localization of epileptiform activity coincide, in one case (14.3%), both the localization of epileptiform activity and deceleration and the focus of ischemia coincide.
The fourth group consists of 8 subjects (20.5%) and is characterized by the absence of pathological changes on the EEG. Among them, 4 women (50%) and 4 men (50%). The age range of this group is 56-83 years, the average age in the group is 70.6.
In 12.5% (1 person) of the studied patients, acute cerebral circulatory disorder was detected according to the hemorrhagic type, in 87.5% (7 people) – according to the ischemic type. Subtypes of ischemic stroke in this subgroup were distributed as follows: cardioembolic-4 cases (57.1%), unspecified-3 cases (42.9%)
Pools: left middle cerebral artery-6 people (85.7%), right middle cerebral artery + vertebrobasillary pool-1 person (14.3%). The number of fatal cases is 3 (37.5%).
In total, the mortality rate was 53.8% (21 cases). In the first group, 6 deaths (28.6%) can be distinguished, in the second group - 4 deaths (19%), in the third group - 8 deaths (38%), in the fourth group-3 deaths (14.3%).
Conclusion:
Most often, there were cases in which both epileptiform activity and deceleration were recorded on the EEG. The same group has the highest mortality rate, at 38%. High mortality is also observed in the group with epileptiform activity - 28.6%.
Within each group of subjects, the number of adverse outcomes is highest in the first group-66.7%, where epileptiform activity is recorded. Similarly, in the second and third groups, the mortality rate is 57.1% and 53.3%, respectively. The lowest mortality rate was in the group without changes on the EEG - 37.5%
Thus, it can be concluded that the registration of epileptiform activity in combination with a slowdown or the presence of only epileptiform activity on the EEG is an unfavorable sign in patients with acute cerebrovascular accident in combination with acute symptomatic convulsive seizures. Most often, fatal cases were observed when the localization of epileptiform activity and deceleration coincided, when the localization of the focus of ischemia and slow-wave activity coincided, with diffuse deceleration, as well as when the focus of ischemia and the localization of epileptiform activity coincided.
About the authors
Lyudmila Ruslanovna Ayubova
Voronezh State Medical University named after N. N. Burdenko
Author for correspondence.
Email: lyudmila.ayubova@gmail.com
ORCID iD: 0000-0002-2885-3051
SPIN-code: 5302-0774
Russian Federation, 10 Studencheskaya str., Voronezh, Russia, 394036
Anastasia Vadimovna Kaliushko
Voronezh State Medical University named after N. N. Burdenko
Email: junojun@yandex.ru
ORCID iD: 0000-0002-1288-6297
SPIN-code: 8134-3322
10 Studencheskaya str., Voronezh, Russia, 394036
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