TOPLINE:

Carotid revascularization was associated with a reduced risk for short- and long-term incident seizures or epilepsy compared with no revascularization in patients with carotid stenosis, new research showed. This protective effect persisted among those who experienced cerebrovascular events following the procedure and across different types of revascularization.

METHODOLOGY:

• Researchers used the TriNetX research network to obtain data for patients with carotid stenosis who underwent carotid artery stenting or carotid endarterectomy within 1 month of diagnosis.
• Overall, 41,225 patients (mean age, 70 years; 64% men) were propensity score-matched with control patients who did not undergo revascularization, based on demographics and major vascular comorbidities.
• Symptomatic (38%) and asymptomatic (62%) patients — defined by the presence or absence of ischemic attack or stroke within 6 months prior to stenosis diagnosis — who underwent revascularization, were score-matched with control individuals without the procedure.
• The primary outcome was a composite of new-onset epilepsy or seizures, assessed at 1 month, 3 months, and 2 years of follow-up.

TAKEAWAY:

• Patients who underwent carotid revascularization had a significantly lower risk for seizures or epilepsy compared with those who did not. Incidence rates were 0.3% at 1 month, 0.4% at 3 months, and 0.8% at 2 years, with hazard ratios (HRs) of 0.30, 0.36, and 0.41, respectively.
• In symptomatic patients who underwent carotid endarterectomy, the incidence of epilepsy or seizures was 0.3% at 1 month (HR, 0.16), 0.5% at 3 months (HR, 0.20), and 1.0% at 2 years (HR, 0.26). The corresponding incidences among asymptomatic patients were 0.2% (HR, 0.33), 0.2% (HR, 0.38), and 0.5% (HR, 0.47), respectively.
• In symptomatic patients who underwent carotid artery stenting, the incidence of epilepsy or seizures was 0.6% at 1 month (HR, 0.32), 0.9% at 3 months (HR, 0.39), and 1.6% at 2 years (HR, 0.44). The corresponding incidences among asymptomatic patients were 0.3% (HR, 0.49), 0.4% (HR, 0.62), and 0.5% (HR, 0.48), respectively.
• Revascularization in patients who experienced cerebrovascular events after receiving a diagnosis of carotid stenosis was associated with a lower incidence of epilepsy or seizures at 3 months (0.3% vs 1.2%; HR, 0.27) and 2 years (1.1% vs 3.0%; HR, 0.35).

IN PRACTICE:

“These findings suggest that the benefits of carotid intervention may extend beyond stroke prevention,” the investigators wrote.

“Clinically, incorporating seizure risk into the broader outcome profile of carotid revascularization may help refine patient counseling and inform treatment selection,” they added. 

SOURCE:

The study was led by Ming-Tsung Chuang, National Cheng Kung University Hospital, Tainan, Taiwan. It was published online on April 8 in Epilepsia. 

LIMITATIONS:

Limitations of the database prevented detailed assessment of the severity of stenosis or plaque features at the individual level and did not allow classification of epilepsy subtypes. The final infarct size and baseline stroke severity among symptomatic patients who did not undergo revascularization may have led to residual confounding. Administrative coding may have misclassified seizure events or procedures. Some symptomatic patients with strokes unrelated to ipsilateral carotid stenosis may have been included, introducing misclassification bias. Different follow-up durations could have led to unequal detection of seizures and epilepsy between groups. 

DISCLOSURES:

The study received no funding. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.