Specificity and sensitivity of the SeLECT score in predicting late seizures in patients undergoing intravenous thrombolytic treatment and the effect of diabetes mellitus and leukoaraiosis

Abstract Background Seizures after stroke can negatively affect the prognosis of ischemic stroke and cause a decrease in quality of life. The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment in acute ischemic stroke has been demonstrated in many studies, and IV rt-PA treatment has been increasingly used around the world. The SeLECT score is a useful score for the prediction of late seizures after stroke and includes the severity of stroke (Se), large artery atherosclerosis (L), early seizure (E), cortical involvement (C), and the territory of the middle cerebral artery (T). However, the specificity and sensitivity of the SeLECTscore have not been studied in acute ischemic stroke patients that received IV rt-PA treatment. Objective In the present study, we aimed to validate and develop the SeLECT score in acute ischemic stroke patients receiving IV rt-PA treatment. Methods The present study included 157 patients who received IV thrombolytic treatment in our third-stage hospital. The 1-year seizure rates of the patients were detected. SeLECT scores were calculated. Results In our study, we found that the SeLECT score had low sensitivity but high specificity for predicting the likelihood of late seizure after stroke in patients administered IV rt-PA therapy. In addition to the SeLECT score, we found that the specificity and sensitivity were higher when we evaluated diabetes mellitus (DM) and leukoaraiosis. Conclusion We found that DM was an independent risk factor for late seizures after stroke in a patient group receiving thrombolytic therapy, and late seizures after stroke were less frequent in patients with leukoaraiosis.

摘要 背景
脑卒中后癫痫可对缺血性脑卒中的预后产生不良影响，并导致患者生活质量下降。多项研究已证实静脉（IV）重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator, rt-PA）治疗急性缺血性脑卒中的临床疗效，该疗法目前在全球范围内的应用愈发广泛。SeLECT评分（SeLECT score）是预测脑卒中后迟发性癫痫的有效工具，其评估维度涵盖脑卒中严重程度（Se）、大动脉粥样硬化（L）、早期癫痫（E）、皮层受累（C）以及大脑中动脉供血区域（T）。但目前尚未有研究针对接受静脉rt-PA治疗的急性缺血性脑卒中患者，评估SeLECT评分的特异度与灵敏度。
目的
本研究旨在针对接受静脉rt-PA治疗的急性缺血性脑卒中患者，验证并拓展SeLECT评分的应用价值。
方法
本研究纳入某三级医院接受静脉溶栓治疗的157例患者，对其1年癫痫发生率进行随访检测，并计算所有受试者的SeLECT评分。
结果
本研究发现，在接受静脉rt-PA治疗的患者群体中，SeLECT评分对脑卒中后迟发性癫痫的预测灵敏度较低，但特异度较高。此外，相较于单独使用SeLECT评分，纳入糖尿病（diabetes mellitus, DM）与脑白质疏松症（leukoaraiosis）进行评估时，模型的特异度与灵敏度均有所提升。
结论
本研究证实，在接受溶栓治疗的患者中，糖尿病是脑卒中后迟发性癫痫的独立危险因素；而合并脑白质疏松症的患者，其脑卒中后迟发性癫痫的发生率显著更低。