Slight Association Identified Between Cerebral Microbleeds and Acute Symptomatic Seizures
August 22, 2023
Article published by AJMC
Findings from a retrospective study of hospitalized patients with anterior circulation ischemic stroke showed an association between cerebral microbleeds (CMBs) and acute symptomatic seizures (ASS). However, this connection was attenuated after accounting for multiple different covariates.
The study is published in Epilepsy & Behavior.
“The presence of CMB alone would be insufficient to explain the onset of seizures after stroke as this is a gradual process, reflecting the prolonged effects of stroke risk factors on cerebral small vessels,” lead author Alain Z. Looti, MD, MS, assistant professor, Penn State Neuroscience Institute, and colleagues, wrote. “The presence of cerebral microbleeds may thus indicate a patient with greater risk factors for stroke and thus more likely to have a more severe stroke. Stroke severity, which is associated with an increased risk of seizures, could therefore potentially mediate the relationship between CMB and seizures.”
Among a cohort of 381 participants, 17 (4.4%) patients had seizures during hospitalization after the index stroke. On an univariable analysis, the presence of 4 or more CMBs (odds ratio [OR], 3.84; 95% CI, 1.16-12.71) and stroke etiologies were associated with ASS. After adjusting for confounders such as stroke severity, cortical infarct location, and hemorrhagic transformation, the association between CMBs and ASS was reduced (adjusted OR, 3.11; 95% CI, 0.74-11.03; P = .09).
In this single center study, multivariable logistic regression analysis showed that patients with a stroke of undetermined cause were found to be more likely to have ASS (adjusted OR, 5.09; 95% CI, 1.17-35.25; P = .05). A summary of ASS characteristics revealed that time to seizure after stroke was less than 1 day in 71% of the cases, 47% of the ASS were focal, status epilepticus was observed in 6%, and most patients had started on levetiracetam. In causal mediation analysis, findings showed that the effect of CMB on ASS was not mediated by stroke severity.