Thrombolysis Treatment For Seizure And Stroke: Safe Or Not?

Thrombolysis is a treatment for acute ischemic stroke that involves administering drugs to dissolve blood clots. It is a time-sensitive procedure, with treatment benefits decreasing over time. The use of intravenous thrombolysis and endovascular mechanical thrombectomy are considered the standard of care for acute ischemic stroke. However, the impact of thrombolysis on the occurrence of post-stroke seizures is unclear. While some studies have shown an association between thrombolysis and the occurrence of seizures, others have not found a significant link. The latest research suggests that thrombolysis does not increase the risk of post-stroke seizures, but more research is needed to confirm this.

Thrombolysis and thrombectomy are not contraindicated in patients with seizures at stroke onset

In a study by Brigo et al., it was found that seizures occurring within 7 days of the cerebrovascular event submitted to reperfusion therapies were associated with cortical stroke involvement, usually focal without impairment of awareness or generalized convulsive, and occur mostly within the first 3 days.

In another study, it was found that the use of intravenous thrombolysis and mechanical thrombectomy does not increase the risk of acute symptomatic seizures in patients with ischemic stroke.

Seizures at stroke onset are not a contraindication to recanalization

The current guidelines for the treatment of acute ischemic stroke exclude patients with seizure at stroke onset from consideration for thrombolytic therapy. However, seizures at stroke onset are not a contraindication to recanalization.

The rationale for this criterion might be that seizures with post-ictal deficits (Todd's paralysis) can mimic ischemic stroke, and thrombolysis would be performed in this case only with risk and no possible benefit. On the other hand, it is possible that immediate seizures are the first presenting symptoms of ischemic stroke. This problem can be solved by the use of MRI with diffusion-weighted imaging, by which acute ischemic changes in the brain can reliably be detected.

The use of intravenous thrombolysis and mechanical thrombectomy is not associated with an increased risk of post-stroke seizures. However, the impact of recanalization therapies on the frequency of post-stroke seizures is unclear.

The occurrence of seizures following stroke is associated with an unfavorable functional and vital outcome of patients who have had a stroke.

Seizures at stroke onset are not a contraindication to intravenous thrombolysis

The European license and American Heart Association guidelines regard seizures at stroke onset as situations where thrombolysis should not be performed. However, it is possible that immediate seizures are the first presenting symptoms of ischemic stroke.

In a retrospective study, researchers explored the clinical and stroke characteristics of patients treated with thrombolysis and/or mechanical thrombectomy for an acute stroke and experiencing early post-stroke seizures within 7 days of the cerebrovascular accident. The study found that seizures occurring within 7 days of the cerebrovascular event submitted to reperfusion therapies were associated with cortical stroke involvement, usually focal without impairment of awareness or generalized convulsive, and occur mostly within the first 3 days.

In a retrospective case series, the largest published so far providing details on clinical features of patients with early post-stroke seizures following different reperfusion therapies, not only restricted to intravenous (IV) thrombolysis, found that early post-stroke seizures following reperfusion therapies are associated with cortical stroke involvement, are usually focal without impairment of awareness or generalized convulsive, and occur mostly within the first 3 days.

A recent meta-analysis also found that the use of recombinant tissue plasminogen activator (r-tPA) had no effect on acute symptomatic seizures or post-stroke epilepsy.

Seizures at stroke onset are not a contraindication to mechanical thrombectomy

Thrombolysis is generally not recommended for patients with seizures at stroke onset. Both the European license and American Heart Association guidelines regard seizures at stroke onset as situations where thrombolysis should not be performed. However, the use of mechanical thrombectomy for patients with seizures at stroke onset is not contraindicated.

Seizures at stroke onset are not a contraindication to bridging therapy

The use of intravenous thrombolysis and mechanical thrombectomy, applied individually or together, are the most frequently employed treatment in the acute phase of an ischemic stroke. However, there is no strong association between thrombolysis and post-stroke seizures. In fact, a retrospective case series found that seizures following reperfusion therapies are associated with cortical stroke involvement, are usually focal without impairment of awareness or generalized convulsive, and occur mostly within the first 3 days.

The American Heart Association (AHA)/American Stroke Association (ASA) guidelines do not recommend the primary preventive administration of anti-seizure medication (ASM) after stroke. However, ASM therapy is generally recommended as a secondary prevention measure in established post-stroke epilepsy, or in any case of status epilepticus.

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