Systemic Thrombolysis and Post-stroke Epilepsy

Introduction. Systemic thrombolysis is a highly effective treatment for ischemic stroke. The effect of thrombolysis on the development of post-stroke epilepsy (PSE) remains a subject of scientific debate. The aim of this study was to clarify the clinical and neuroimaging features of PSE in patients with ischemic stroke, who underwent systemic thrombolysis. Materials and methods . A total of 46 patients after ischemic stroke were examined, including 33 men and 13 women aged 28 to 80 years. Group I consisted of 9 patients with PSE after systemic thrombolysis with rtPA (alteplase) at a dose of 0.9 mg/kg. Group II included 8 patients without PSE after systemic thrombolysis. Group III consisted of 29 patients with PSE, who received standard drug therapy. Comparative group analysis took into account the medical history, clinical and neuroimaging data. Results . Patients with PSE were characterized by the absence of clinical effect after systemic thrombolysis ( p = 0.026); infarcts extending to the frontal and insular lobes ( p = 0.038), insular lobe and basal nuclei ( p = 0.026); development of a hemorrhagic component in the cerebral cortex ( p = 0.005), as well as in the territory of the deep and terminal branches of the middle cerebral artery (MCA) ( p = 0.006). Conclusions. Development of PSE is associated with ineffective systemic thrombolysis and the appearance of extensive and large cerebral infarcts with a hemorrhagic component.