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Article ; Online: Association between implementation of a code stroke system and poststroke epilepsy.

Chen, Ziyi / Churilov, Leonid / Chen, Ziyuan / Naylor, Jillian / Koome, Miriam / Yan, Bernard / Kwan, Patrick

2018 Volume 90, Issue 13, Page(s) e1126–e1133

Abstract: Objective: We aimed to investigate the effect of a code stroke system on the development of poststroke epilepsy.: Methods: We retrospectively analyzed consecutive patients treated with IV thrombolysis under or outside the code stroke system between ... ...

Abstract	Objective: We aimed to investigate the effect of a code stroke system on the development of poststroke epilepsy. Methods: We retrospectively analyzed consecutive patients treated with IV thrombolysis under or outside the code stroke system between 2003 and 2012. Patients were followed up for at least 2 years or until death. Factors with Results: A total of 409 patients met the eligibility criteria. Their median age at stroke onset was 75 years (interquartile range 64-83 years); 220 (53.8%) were male. The median follow-up duration was 1,074 days (interquartile range 119-1,671 days). Thirty-two patients (7.8%) had poststroke seizures during follow-up, comprising 7 (1.7%) with acute symptomatic seizures and 25 (6.1%) with late-onset seizures. Twenty-six patients (6.4%) fulfilled the definition of poststroke epilepsy. Three hundred eighteen patients (77.8%) were treated with the code stroke system while 91 (22.2%) were not. After adjustment for age and stroke etiology, use of the code stroke system was associated with decreased odds of poststroke epilepsy (odds ratio = 0.36, 95% confidence interval 0.14-0.87, Conclusion: The code stroke system was associated with reduced odds and instantaneous risk of poststroke epilepsy. Further studies are required to identify the contribution of the individual components and mechanisms against epileptogenesis after stroke. Classification of evidence: This study provides Class III evidence that for people with acute ischemic stroke, implementation of a code stroke system reduces the risk of poststroke epilepsy.
MeSH term(s)	Aged ; Aged, 80 and over ; Brain Ischemia/complications ; Brain Ischemia/epidemiology ; Brain Ischemia/therapy ; Clinical Protocols ; Disease Management ; Emergency Medical Services/methods ; Epilepsy/epidemiology ; Epilepsy/etiology ; Female ; Fibrinolytic Agents/therapeutic use ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Stroke/complications ; Stroke/epidemiology ; Stroke/therapy ; Thrombolytic Therapy ; Tissue Plasminogen Activator/therapeutic use
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2018-02-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000005212
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Article ; Online: Reliability and Utility of the Alberta Stroke Program Early Computed Tomography Score in Hyperacute Stroke.

Naylor, Jillian / Churilov, Leonid / Rane, Neil / Chen, Ziyuan / Campbell, Bruce C V / Yan, Bernard

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2017 Volume 26, Issue 11, Page(s) 2547–2552

Abstract: Goal: The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on non-contrast computed tomography (NCCT) is dependent on the visibility of early ischemic change. The goal of our study was to evaluate whether time from ischemic stroke onset ... ...

Abstract	Goal: The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on non-contrast computed tomography (NCCT) is dependent on the visibility of early ischemic change. The goal of our study was to evaluate whether time from ischemic stroke onset to initial NCCT influences the inter-rater variability and prognostic accuracy of ASPECTS for a 3-month functional outcome. Materials and methods: Ischemic stroke patients treated with intravenous tissue plasminogen activator (IV-tPA) from 2007 to 2014 at the Royal Melbourne Hospital were included. ASPECTS were blindly assessed by 2 independent raters with inter-rater agreement determined by weighted kappa. Onset time to computed tomography time was dichotomized at the median (≤100 and >100 minutes). Outcome was assessed using the modified Rankin Scale. Logistic regression and receiver operating characteristic analysis were used to assess the prognostic utility of ASPECTS in the early and later time periods. Results: There were 379 patients included. Inter-rater agreement was significantly lower in the early time period: kappa = .75 (95% confidence interval (CI), .59-.84) ≤ 100 minutes versus .92 (95% CI, .91-.93) > 100 minutes, P < .001. The distributions of absolute inter-rater differences in ASPECTS differed significantly between time epochs (P = .03). The prognostic accuracies of ASPECTS across time epochs were area under the receiver operating characteristic curve ≤ 100 minutes = .57 (95% CI, .50-.64) and >100 minutes = .66 (95% CI, .59-.73), P = .055. Conclusions: This study demonstrated a significantly lower inter-rater agreement and a trend toward reduced prognostic accuracy of ASPECTS in earlier time periods. The use of ASPECTS to select patients for revascularization in early time windows may be unreliable.
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2017.05.042
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Article ; Online: Post-Stroke Seizures Is Associated with Low Alberta Stroke Program Early CT Score.

Chen, Ziyuan / Churilov, Leonid / Koome, Miriam / Chen, Ziyi / Naylor, Jillian / Kwan, Patrick / Yan, Bernard

Cerebrovascular diseases (Basel, Switzerland)

2017 Volume 43, Issue 5-6, Page(s) 259–265

Abstract: Background: Ischemic stroke is a leading cause of new-onset seizures. Cortical ischemia and large ischemic lesion size are among the most consistently reported risk factors for post-stroke seizures. Alberta Stroke Program Early CT Score (ASPECTS) is a ... ...

Abstract	Background: Ischemic stroke is a leading cause of new-onset seizures. Cortical ischemia and large ischemic lesion size are among the most consistently reported risk factors for post-stroke seizures. Alberta Stroke Program Early CT Score (ASPECTS) is a simple and reliable tool for quantifying the extent of cerebral ischemia and may function as a screening tool for patients with high risk of seizure development. We investigated the association of post-stroke seizures with the extent of ischemia assessed by ASPECTS and with cortical involvement identified on non-contrast CT (NCCT). Methods: This cohort study was based on a prospectively maintained clinical database of acute ischemic stroke patients who were given intravenous tissue plasminogen activator treatment. We included patients with anterior circulation stroke admitted between January 2008 and October 2014. Patients with pre-stroke seizures were excluded. Clinical data and seizure follow-up data were collected. NCCT scans acquired both on stroke admission and at 24 h were analyzed. Logistic regression and cox regression were performed in statistical analysis. Results: A total of 348 patients (median age 73 years, interquartile range [IQR] 63-80, 55% male) were included. During follow-up (median duration 559 days, IQR 107.5-1188.5 days), 22 (6.3%) patients developed post-stroke seizures. Median time from stroke to seizure onset was 138 days (IQR 10-342 days). In univariate logistic regression, both ASPECTS on admission (OR 0.69 per 1-point increase; 95% CI 0.55-0.86; p = 0.001) and at 24 h (OR 0.80 per 1-point increase; 95% CI 0.70-0.92; p = 0.002) were significantly associated with post-stroke seizures. Cortical involvement at 24 h also correlated with seizure occurrence (OR 3.01; 95% CI 1.08-8.34; p = 0.03). Cox regression confirmed the higher risk of developing seizures at any time point in patients with lower ASPECTS value and cortical ischemia. Of note, ASPECTS was the only independent predictor for post-stroke seizures in multivariate logistic regression. Conclusion: The extent of ischemia assessed by ASPECTS and cortical involvement identified on NCCT were associated with the development of post-stroke seizures.
MeSH term(s)	Administration, Intravenous ; Aged ; Aged, 80 and over ; Brain Ischemia/complications ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/drug therapy ; Cerebral Cortex/diagnostic imaging ; Databases, Factual ; Female ; Fibrinolytic Agents/administration & dosage ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Seizures/diagnosis ; Seizures/etiology ; Stroke/complications ; Stroke/diagnostic imaging ; Stroke/drug therapy ; Thrombolytic Therapy ; Time Factors ; Tissue Plasminogen Activator/administration & dosage ; Tomography, X-Ray Computed
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2017-03-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1069462-6
ISSN	1421-9786 ; 1015-9770
ISSN (online)	1421-9786
ISSN	1015-9770
DOI	10.1159/000458449
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Zs.A 3181: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Reliability, Reproducibility and Prognostic Accuracy of the Alberta Stroke Program Early CT Score on CT Perfusion and Non-Contrast CT in Hyperacute Stroke.

Naylor, Jillian / Churilov, Leonid / Chen, Ziyuan / Koome, Miriam / Rane, Neil / Campbell, Bruce C V

Cerebrovascular diseases (Basel, Switzerland)

2017 Volume 44, Issue 3-4, Page(s) 195–202

Abstract: Background: Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic change on non-contrast CT (NCCT). We hypothesised that assessing ASPECTS regions on CT Perfusion (CTP) rather than NCCT would improve inter-rater agreement and ... ...

Abstract	Background: Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic change on non-contrast CT (NCCT). We hypothesised that assessing ASPECTS regions on CT Perfusion (CTP) rather than NCCT would improve inter-rater agreement and prognostic accuracy, particularly in patients presenting early after stroke onset. Methods: Ischemic stroke patients treated with intravenous alteplase from 2009 to 2014 at our institution were included in this study. Inter-rater agreement and prognostic accuracy of ASPECTS across modalities were analysed by the time between stroke onset and initial NCCT, dichotomized 1st quartile versus quartiles 2-4, referred to as epochs. ASPECTS was assessed by 2 independent raters, blinded to stroke onset time, with agreement determined by weighted kappa (κw). Prognostic accuracy for favourable outcome (modified Rankin Scale 0-2) was assessed using the receiver-operating characteristic analysis. Results: A total of 227 participants were included. There was significant time-by-CT modality interaction for ASPECTS, p < 0.0001. The inter-rater agreement of ASPECTS on NCCT significantly increased as onset to CT time increased (κw epoch 1 = 0.76 vs. κw epoch 2-4 = 0.89, p = 0.04), whereas agreement using CTP parameters was stable across epochs. Inter-rater agreement for CTP-ASPECTS was significantly higher than NCCT in early epoch: Tmax κw = 0.96, p = 0.002; cerebral blood volume (CBV) κw = 0.95, p = 0.003; cerebral blood flow (CBF) κw = 0.94, p = 0.006, with no differences in the later epochs. Prognostic accuracy of ASPECTS on NCCT in epoch 1 were (area under the ROC curves [AUC] = 0.52, 95% CI 0.48-0.56), CBV (AUC = 0.55, 95% CI 0.42-0.69, CBF (AUC = 0.58, 95% CI 0.46-0.71) and Tmax (AUC = 0.62, 95% CI 0.49-0.75), p = 0.46 between modalities. Conclusions: CTP can improve reliability when assessing the extent of ischemic changes, particularly in patients imaged early after stroke onset.
MeSH term(s)	Area Under Curve ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/physiopathology ; Cerebral Angiography/methods ; Cerebrovascular Circulation ; Computed Tomography Angiography ; Decision Support Techniques ; Humans ; Multidetector Computed Tomography ; Observer Variation ; Perfusion Imaging/methods ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Reproducibility of Results ; Retrospective Studies ; Severity of Illness Index ; Stroke/diagnostic imaging ; Stroke/physiopathology ; Victoria
Language	English
Publishing date	2017-08-16
Publishing country	Switzerland
Document type	Comparative Study ; Journal Article
ZDB-ID	1069462-6
ISSN	1421-9786 ; 1015-9770
ISSN (online)	1421-9786
ISSN	1015-9770
DOI	10.1159/000479707
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Article: Examining the Minimal Important Difference of Patient-reported Outcome Measures for Individuals with Knee Osteoarthritis: A Model Using the Knee Injury and Osteoarthritis Outcome Score.

Mills, Kathryn A G / Naylor, Justine M / Eyles, Jillian P / Roos, Ewa M / Hunter, David J

The Journal of rheumatology

2016 Volume 43, Issue 2, Page(s) 395–404

Abstract: Objective: To examine the influence of different analytical methods, baseline covariates, followup periods, and anchor questions when establishing a minimal important difference (MID) for individuals with knee osteoarthritis (OA). Second, to propose MID ...

Abstract	Objective: To examine the influence of different analytical methods, baseline covariates, followup periods, and anchor questions when establishing a minimal important difference (MID) for individuals with knee osteoarthritis (OA). Second, to propose MID for improving and worsening on the Knee injury and Osteoarthritis Outcome Score (KOOS). Methods: Retrospective analysis of prospectively collected data from 272 patients with knee OA undergoing a multidisciplinary nonsurgical management strategy. The magnitude and rate of change as well as the influence of baseline covariates were examined for 5 KOOS subscales over 52 weeks. The MID for improving and worsening were investigated using 4 anchor-based methods. Results: Waitlisted for joint replacement and exhibiting unilateral/bilateral symptoms influenced change in KOOS over time. Generally, low correlations between anchors and KOOS change scores limited calculations of MID; thus, they were only proposed for the pain, activities of daily living, and quality of life subscales. The method used to calculate the MID influenced the cutpoint; however, the type of anchor question only influenced the MID when analyzed with a particular mean change method. Depending on patient and clinical characteristics, the subscale, and the analytical approach used, the MID for KOOS improvement ranged from an absolute change of -1.5 to 20.6 points and worsening ranged from -19.17 to 8.5 points. Conclusion: MID vary with patient and clinical characteristics, KOOS subscale, and analytical approach. Provided the anchor question is relevant to the patient-reported outcome and baseline status is considered, the anchor does not appear to influence the MID for improvement or worsening when using some anchor-based methods.
MeSH term(s)	Activities of Daily Living ; Arthroplasty, Replacement, Knee ; Disability Evaluation ; Female ; Humans ; Knee Joint/surgery ; Male ; Osteoarthritis, Knee/surgery ; Patient Outcome Assessment ; Quality of Life ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2016-02
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.150398
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Zs.A 1168: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Association between hemorrhagic transformation after endovascular therapy and poststroke seizures.

Thevathasan, Arthur / Naylor, Jillian / Churilov, Leonid / Mitchell, Peter J / Dowling, Richard J / Yan, Bernard / Kwan, Patrick

Epilepsia

2017 Volume 59, Issue 2, Page(s) 403–409

Abstract: Objective: Endovascular therapy has recently become standard therapy for select patients with acute ischemic stroke. Infarcted brain tissue may undergo hemorrhagic transformation (HT) after endovascular therapy. We investigated the association between ... ...

Abstract	Objective: Endovascular therapy has recently become standard therapy for select patients with acute ischemic stroke. Infarcted brain tissue may undergo hemorrhagic transformation (HT) after endovascular therapy. We investigated the association between HT and occurrence of poststroke seizures in patients treated with endovascular therapy. Methods: Consecutive patients treated with endovascular therapy for acute anterior circulation ischemic stroke were included. HT was assessed with computed tomography/magnetic resonance imaging (CT/MRI) at 24 h after stroke onset. Patients were followed for up to 2 years for seizure occurrence. Results: A total of 205 (57.1% male) patients were analyzed. Median age was 69 years (interquartile range [IQR] 57-78). Among patients with HT, 17.9% (10/56) developed poststroke seizures compared with 4.0% (6/149) among those without HT (hazard ratio [HR] 5.52; 95% confidence interval [CI] 2.00-15.22; P = .001). The association remained significant after adjustment for cortical involvement, baseline National Institutes of Health Stroke Scale score, age and use of intravenous tissue plasminogen activator and clot retrieval (HR 4.85; 95% CI 1.60-14.76; P = .005). In patients who developed seizures within the follow-up period, median time to first seizure was 111 days (IQR 28-369) in patients with HT and 36 days (IQR 0.5-183) in patients without HT. Significance: A patient who develops HT following endovascular therapy for acute ischemic stroke had a nearly 5 times higher rate of developing poststroke seizures within 2 years. HT may be used as an imaging biomarker for poststroke seizures.
MeSH term(s)	Adult ; Aged ; Brain Infarction/diagnostic imaging ; Brain Infarction/drug therapy ; Brain Infarction/surgery ; Endovascular Procedures ; Female ; Fibrinolytic Agents/therapeutic use ; Humans ; Intracranial Hemorrhages/diagnostic imaging ; Intracranial Hemorrhages/epidemiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Complications/diagnostic imaging ; Postoperative Complications/epidemiology ; Postoperative Hemorrhage/diagnostic imaging ; Postoperative Hemorrhage/epidemiology ; Proportional Hazards Models ; Risk Factors ; Seizures/epidemiology ; Stroke/diagnostic imaging ; Stroke/drug therapy ; Stroke/surgery ; Tissue Plasminogen Activator/therapeutic use ; Tomography, X-Ray Computed ; Young Adult
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2017-12-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/epi.13982
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Zs.A 517: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Reliability, Reproducibility and Prognostic Accuracy of the Alberta Stroke Program Early CT Score on CT Perfusion and Non-Contrast CT in Hyperacute Stroke

Naylor, Jillian / Churilov, Leonid / Chen, Ziyuan / Koome, Miriam / Rane, Neil / Campbell, Bruce C.V.

Cerebrovascular Diseases

2017 Volume 44, Issue 3-4, Page(s) 195–202

Institution	Melbourne Brain Centre, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Parkville, VIC, Australia
Abstract	Background: Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic change on non-contrast CT (NCCT). We hypothesised that assessing ASPECTS regions on CT Perfusion (CTP) rather than NCCT would improve inter-rater agreement and prognostic accuracy, particularly in patients presenting early after stroke onset. Methods: Ischemic stroke patients treated with intravenous alteplase from 2009 to 2014 at our institution were included in this study. Inter-rater agreement and prognostic accuracy of ASPECTS across modalities were analysed by the time between stroke onset and initial NCCT, dichotomized 1st quartile versus quartiles 2-4, referred to as epochs. ASPECTS was assessed by 2 independent raters, blinded to stroke onset time, with agreement determined by weighted kappa (κw). Prognostic accuracy for favourable outcome (modified Rankin Scale 0-2) was assessed using the receiver-operating characteristic analysis. Results: A total of 227 participants were included. There was significant time-by-CT modality interaction for ASPECTS, p < 0.0001. The inter-rater agreement of ASPECTS on NCCT significantly increased as onset to CT time increased (κw epoch 1 = 0.76 vs. κw epoch 2-4 = 0.89, p = 0.04), whereas agreement using CTP parameters was stable across epochs. Inter-rater agreement for CTP-ASPECTS was significantly higher than NCCT in early epoch: Tmax κw = 0.96, p = 0.002; cerebral blood volume (CBV) κw = 0.95, p = 0.003; cerebral blood flow (CBF) κw = 0.94, p = 0.006, with no differences in the later epochs. Prognostic accuracy of ASPECTS on NCCT in epoch 1 were (area under the ROC curves [AUC] = 0.52, 95% CI 0.48-0.56), CBV (AUC = 0.55, 95% CI 0.42-0.69, CBF (AUC = 0.58, 95% CI 0.46-0.71) and Tmax (AUC = 0.62, 95% CI 0.49-0.75), p = 0.46 between modalities. Conclusions: CTP can improve reliability when assessing the extent of ischemic changes, particularly in patients imaged early after stroke onset.
Keywords	ASPECTS ; Hyperacute stroke ; CT Perfusion ; NCCT
Language	English
Publishing date	2017-08-16
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Original Paper
ZDB-ID	1069462-6
ISSN	1421-9786 ; 1015-9770
ISSN (online)	1421-9786
ISSN	1015-9770
DOI	10.1159/000479707
Database	Karger publisher's database

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Zs.A 3181: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Computed tomography perfusion as a diagnostic tool for seizures after ischemic stroke.

Koome, Miriam / Churilov, Leonid / Chen, Ziyuan / Chen, Ziyi / Naylor, Jillian / Thevathasan, Arthur / Yan, Bernard / Kwan, Patrick

Neuroradiology

2016 Volume 58, Issue 6, Page(s) 577–584

Abstract: Introduction: Cerebral cortical ischemia is a risk factor for post-stroke seizures. However, the optimal imaging method is unclear. We investigated CT perfusion (CTP) in detecting cortical ischemia and its correlation with post-stroke seizures compared ... ...

Abstract	Introduction: Cerebral cortical ischemia is a risk factor for post-stroke seizures. However, the optimal imaging method is unclear. We investigated CT perfusion (CTP) in detecting cortical ischemia and its correlation with post-stroke seizures compared with non-contrast CT (NCCT). Methods: We included patients with acute ischemic stroke admitted to the Royal Melbourne Hospital between 2009 and 2014. Post-stroke seizure information was collected. Cortical involvement was determined on acute NCCT and CTP (T max, cerebral blood volume [CBV], and cerebral blood flow [CBF]). The association between cortical involvement detected by different imaging modalities and post-stroke seizures was examined. Results: Three-hundred fifty-two patients were included for analysis. Fifty-nine percent were male, and median age was 73 years (inter-quartile range 61-82). Follow-up was available for 96 %; median follow-up duration was 377 days (inter-quartile range 91-1018 days). Thirteen patients had post-stroke seizures (3.9 %). Cortical involvement was significantly associated with post-stroke seizures across all modalities. CBV had the highest hazard ratio (11.3, 95 % confidence interval (CI) 1.1-41.2), followed by NCCT (5.3, 95 % CI 1.5-18.0) and CBF (4.2, 95 % CI 1.1-15.2). Sensitivity was highest for T max (100 %), followed by CBV and CBF (both 76.9 %) and NCCT (63.6 %). Specificity was highest for CBV (77.8 %), then NCCT (75.6 %), CBF (54.0 %), and T max (29.1 %). Receiver-operating characteristic area under the curve was significantly different between imaging modalities (p < 0.001), CBV 0.77, NCCT 0.70, CBF 0.65, and T max 0.65. Conclusion: CTP may improve sensitivity and specificity of cortical involvement for post-stroke seizures compared to NCCT.
Language	English
Publishing date	2016-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	123305-1
ISSN	1432-1920 ; 0028-3940
ISSN (online)	1432-1920
ISSN	0028-3940
DOI	10.1007/s00234-016-1670-5
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Article: Post-Stroke Seizures Is Associated with Low Alberta Stroke Program Early CT Score

Chen, Ziyuan / Churilov, Leonid / Koome, Miriam / Chen, Ziyi / Naylor, Jillian / Kwan, Patrick / Yan, Bernard

Cerebrovascular Diseases

2017 Volume 43, Issue 5-6, Page(s) 259–265

Institution	Melbourne Brain Centre, The Royal Melbourne Hospital, Department of Medicine, Parkville, VIC, Australia School of Medicine, Tsinghua University, Faculty of Medicine, Beijing, China Florey Neuroscience Institutes, Austin Health, University of Melbourne, Heidelberg, VIC, and Department of Medicine, University of Melbourne, Melbourne, VIC, Australia First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Abstract	Background: Ischemic stroke is a leading cause of new-onset seizures. Cortical ischemia and large ischemic lesion size are among the most consistently reported risk factors for post-stroke seizures. Alberta Stroke Program Early CT Score (ASPECTS) is a simple and reliable tool for quantifying the extent of cerebral ischemia and may function as a screening tool for patients with high risk of seizure development. We investigated the association of post-stroke seizures with the extent of ischemia assessed by ASPECTS and with cortical involvement identified on non-contrast CT (NCCT). Methods: This cohort study was based on a prospectively maintained clinical database of acute ischemic stroke patients who were given intravenous tissue plasminogen activator treatment. We included patients with anterior circulation stroke admitted between January 2008 and October 2014. Patients with pre-stroke seizures were excluded. Clinical data and seizure follow-up data were collected. NCCT scans acquired both on stroke admission and at 24 h were analyzed. Logistic regression and cox regression were performed in statistical analysis. Results: A total of 348 patients (median age 73 years, interquartile range [IQR] 63-80, 55% male) were included. During follow-up (median duration 559 days, IQR 107.5-1188.5 days), 22 (6.3%) patients developed post-stroke seizures. Median time from stroke to seizure onset was 138 days (IQR 10-342 days). In univariate logistic regression, both ASPECTS on admission (OR 0.69 per 1-point increase; 95% CI 0.55-0.86; p = 0.001) and at 24 h (OR 0.80 per 1-point increase; 95% CI 0.70-0.92; p = 0.002) were significantly associated with post-stroke seizures. Cortical involvement at 24 h also correlated with seizure occurrence (OR 3.01; 95% CI 1.08-8.34; p = 0.03). Cox regression confirmed the higher risk of developing seizures at any time point in patients with lower ASPECTS value and cortical ischemia. Of note, ASPECTS was the only independent predictor for post-stroke seizures in multivariate logistic regression. Conclusion: The extent of ischemia assessed by ASPECTS and cortical involvement identified on NCCT were associated with the development of post-stroke seizures.
Keywords	Post-stroke seizures ; Alberta Stroke Program Early CT Score ; Non-contrast CT ; Cortical involvement ; Ischemic lesion size
Language	English
Publishing date	2017-03-04
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Original Paper
ZDB-ID	1069462-6
ISSN	1421-9786 ; 1015-9770
ISSN (online)	1421-9786
ISSN	1015-9770
DOI	10.1159/000458449
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Article ; Online: The Association Between Atrial Fibrillation and Poststroke Seizures is Influenced by Ethnicity and Environmental Factors.

Naylor, Jillian / Churilov, Leonid / Johnstone, Benjamin / Guo, Ruibing / Xiong, Yunyun / Koome, Miriam / Chen, Ziyi / Thevathasan, Arthur / Chen, Ziyuan / Liu, Xinfeng / Kwan, Patrick / Campbell, Bruce C V

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2018 Volume 27, Issue 10, Page(s) 2755–2760

Abstract: Goal: Epilepsy is a major complication of stroke. There have been suggestions that patients with cardioembolic stroke are at a greater risk of developing seizures than other stroke subtypes. However, the incidence of atrial fibrillation (AF) and ... ...

Abstract	Goal: Epilepsy is a major complication of stroke. There have been suggestions that patients with cardioembolic stroke are at a greater risk of developing seizures than other stroke subtypes. However, the incidence of atrial fibrillation (AF) and cardioembolic stroke varies considerably across countries, generally higher in Western populations than in Asian populations. This study assessed whether ethnicity affects the association between AF and poststroke seizure (PSS) development. We hypothesized that Royal Melbourne Hospital ([RMH] Melbourne) patients will have significantly higher incidence of AF-related PSS than in the Jinling Hospital (Nanjing) population. Materials and methods: This was a retrospective, multicenter cohort study including patients with anterior circulation ischemic stroke admitted between 2008 and 2015. Occurrences of PSS were ascertained by reviewing medical records or telephone follow-up. To test the hypothesis of an interaction between ethnicity and AF for PSS occurrence, a logistic regression model with AF and ethnicity together with an ethnicity-by-AF interaction term was used. Findings: Of 782 patients followed-up for seizure development at RMH, 247 (31.6%) patients had AF, of whom 10 (4%) developed PSS. Of 1185 patients followed-up and included at JH, 54 (4.8%) patients with AF, of whom 4 (7.4%) developed PSS. At RMH, no significant association was found between AF and PSS; odds ratio .75, 95% confidence interval .4-1.6, (P = .4). At JH, there was a significant association between AF and increased PSS: OR 4.0, 95% CI 1.3-12.1, (P = .01), P for interaction = .03. Conclusion: Further understanding of genetic risks and environmental differences across ethnic populations and the role in PSS is required.
MeSH term(s)	Aged ; Aged, 80 and over ; Asian Continental Ancestry Group/genetics ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/ethnology ; Atrial Fibrillation/genetics ; China/epidemiology ; Environment ; Female ; Gene-Environment Interaction ; Genetic Predisposition to Disease ; Health Status Disparities ; Humans ; Incidence ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Oceanic Ancestry Group/genetics ; Odds Ratio ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Seizures/diagnosis ; Seizures/ethnology ; Stroke/diagnosis ; Stroke/ethnology ; Victoria/epidemiology
Language	English
Publishing date	2018-07-21
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2018.05.044
Database	MEDical Literature Analysis and Retrieval System OnLINE

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