{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:21:19Z","timestamp":1791908479345,"version":"4.3.4"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Acute symptomatic seizures (ASyS) increase the risk of epilepsy and mortality after a stroke. The impact of the timing and type of ASyS remains unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>This multicenter cohort study included data from 9 centers between 2002 and 2018, with a final analysis in February 2024. The study included 4552 adults (2005 female; median age, 73 years) with ischemic stroke and no seizure history. Seizures were classified using International League Against Epilepsy definitions. We examined ASyS occurring within 7 days after stroke. The main outcomes were all-cause mortality and epilepsy. Validation of the updated SeLECT score (SeLECT-ASyS) was performed in 3 independent cohorts (Switzerland, Argentina, and Japan) collected between 2012 and 2024, including 74 adults with ASyS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              The 10-year risk of poststroke epilepsy ranged from 41% to 94%, and mortality from 36% to 100%, depending on ASyS type and timing. ASyS on stroke onset day had a higher epilepsy risk (adjusted hazard ratio [aHR], 2.3 [95% CI, 1.3\u20134.0];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.003) compared with later ASyS. Status epilepticus had the highest epilepsy risk (aHR, 9.6 [95% CI, 3.5\u201326.7];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001), followed by focal to bilateral tonic-clonic seizures (aHR, 3.4 [95% CI, 1.9\u20136.3];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). Mortality was higher in those with ASyS presenting as focal to bilateral tonic-clonic seizures on day 0 (aHR, 2.8 [95% CI, 1.4\u20135.6];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.004) and status epilepticus (aHR, 14.2 [95% CI, 3.5\u201358.8];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001). The updated SeLECT-ASyS model, available as an application, outperformed a previous model in the derivation cohort (concordance statistics, 0.68 versus 0.58;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.02) and in the validation cohort (0.70 versus 0.50;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.18).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>ASyS timing and type significantly affect epilepsy and mortality risk after stroke, improving epilepsy prediction and guiding patient counseling.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.124.050045","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T09:00:52Z","timestamp":1745485252000},"page":"1748-1757","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Association of the Timing and Type of Acute Symptomatic Seizures With Poststroke Epilepsy and Mortality"],"prefix":"10.1161","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1438-7544","authenticated-orcid":true,"given":"Kai Michael","family":"Schubert","sequence":"first","affiliation":[{"name":"Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland (K.M.S., G.B., M.K., L.S., R.T., M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7112-304X","authenticated-orcid":true,"given":"Dominik","family":"Zieglg\u00e4nsberger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kantonsspital St. Gallen, Switzerland (D.Z., N.D., B.E.-C., A.F., P.S., B.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2956-0189","authenticated-orcid":true,"given":"Giulio","family":"Bicciato","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland (K.M.S., G.B., M.K., L.S., R.T., M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5119-7929","authenticated-orcid":true,"given":"Laura","family":"Abraira","sequence":"additional","affiliation":[{"name":"Epilepsy Unit, Department of Neurology, Vall d\u2019Hebron Hospital Universitari, Barcelona; Universitat Autonoma de Barcelona, Bellaterra, Spain (L.A., E.S., J.A.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estevo","family":"Santamarina","sequence":"additional","affiliation":[{"name":"Epilepsy Unit, Department of Neurology, Vall d\u2019Hebron Hospital Universitari, Barcelona; Universitat Autonoma de Barcelona, Bellaterra, Spain (L.A., E.S., J.A.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"\u00c1lvarez-Sab\u00edn","sequence":"additional","affiliation":[{"name":"Epilepsy Unit, Department of Neurology, Vall d\u2019Hebron Hospital Universitari, Barcelona; Universitat Autonoma de Barcelona, Bellaterra, Spain (L.A., E.S., J.A.-S.)."},{"name":"Department of Neurology, University of Muenster, Germany (J.C., S.E.)."},{"name":"Division for Neurodegenerative Diseases, Department of Neurology, Universitaetsmedizin Mannheim, University of Heidelberg, Germany (J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0853-7163","authenticated-orcid":true,"given":"Carolina","family":"Ferreira-Atuesta","sequence":"additional","affiliation":[{"name":"Department of Clinical &amp; Experimental Epilepsy, UCL Queen Square Institute of Neurology, London; Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom (C.F.-A., J.S.D., J.W.S., M.J.K., M.G.)."},{"name":"Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (C.F.-A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9265-8066","authenticated-orcid":true,"given":"Mira","family":"Katan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland (K.M.S., G.B., M.K., L.S., R.T., M.G.)."},{"name":"Department of Neurology, University Hospital and University of Basel, Switzerland (M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9042-3838","authenticated-orcid":true,"given":"Lucia","family":"Sinka","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland (K.M.S., G.B., M.K., L.S., R.T., M.G.)."},{"name":"Department of Neurology, Schulthess Klinik, Zurich, Switzerland (L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1311-5475","authenticated-orcid":true,"given":"Robert","family":"Terziev","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland (K.M.S., G.B., M.K., L.S., R.T., M.G.)."},{"name":"Department of Neurology with Experimental Neurology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Germany (R.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-9127","authenticated-orcid":true,"given":"Nico","family":"Deligas","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kantonsspital St. Gallen, Switzerland (D.Z., N.D., B.E.-C., A.F., P.S., B.T.)."},{"name":"Specialist Clinic for Neurorehabilitation, Kliniken Beelitz, Beelitz-Heilst\u00e4tten, Germany (N.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1466-0412","authenticated-orcid":true,"given":"Barbara","family":"Erd\u00e9lyi-Canavese","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kantonsspital St. Gallen, Switzerland (D.Z., N.D., B.E.-C., A.F., P.S., B.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansgar","family":"Felbecker","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kantonsspital St. Gallen, Switzerland (D.Z., N.D., 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Austria (T.J.O., J.N.W., M.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0776-6821","authenticated-orcid":true,"given":"Judith N.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Johannes Kepler University Linz, Kepler University Hospital, Department of Neurology, Austria (T.J.O., J.N.W., M.W.)."},{"name":"Department of Neurology, Evangelisches Klinikum Gelsenkirchen, Academic Hospital University Essen-Duisburg, Germany (J.N.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3526-1414","authenticated-orcid":true,"given":"Gian Luigi","family":"Gigli","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Italy (G.L.G., A.N., F.J., G.M., 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Bosque, Colombia (M.P.Z.-S., L.C.M.-R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7912-0571","authenticated-orcid":true,"given":"Julian","family":"Conrad","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Muenster, Germany (J.C., S.E.)."},{"name":"Division for Neurodegenerative Diseases, Department of Neurology, Universitaetsmedizin Mannheim, University of Heidelberg, Germany (J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4460-3244","authenticated-orcid":true,"given":"Stefan","family":"Evers","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Muenster, Germany (J.C., S.E.)."},{"name":"Department of Neurology, Krankenhaus Lindenbrunn, Coppenbru\u0308gge, Germany 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