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Consensus-based statements for the management of mitochondrial stroke-like episodes

Nesbitt V.; Horvath R.; Mcfarland R.; Pitceathly R.D.S.; Ng Y.S.; Martikainen M.H.; Gorman G.S.; Klopstock T.; Bindoff L.A.; Mancuso M.; Turnbull D.M.; Schaefer A.M.

Consensus-based statements for the management of mitochondrial stroke-like episodes

Nesbitt V.
Horvath R.
Mcfarland R.
Pitceathly R.D.S.
Ng Y.S.
Martikainen M.H.
Gorman G.S.
Klopstock T.
Bindoff L.A.
Mancuso M.
Turnbull D.M.
Schaefer A.M.
Katso/Avaa
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Lataukset: 

F1000 Research Ltd
doi:10.12688/wellcomeopenres.15599.1
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Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2021042824066
Tiivistelmä

Background: Focal-onset seizures and encephalopathy are prominent features of a stroke-like episode, which is a severe neurological manifestation associated with subtypes of mitochondrial disease. Despite more than 30 years of research, the acute treatment of stroke-like episodes remains controversial.

Methods: We used the modified Delphi process to harness the clinical expertise of a group of mitochondrial disease specialists from five European countries to produce consensus guidance for the acute management of stroke-like episodes and commonly associated complications.

Results: Consensus on a new definition of mitochondrial stroke-like episodes was achieved and enabled the group to develop diagnostic criteria based on clinical features, neuroimaging and/or electroencephalogram findings. Guidelines for the management of strokelike episodes were agreed with aggressive seizure management strongly recommended at the outset of stroke-like episodes.

Conclusions: Our consensus statement defines stroke-like episodes in terms of an epileptic encephalopathy and we have used this to revise both diagnostic criteria and guidelines for management. A prospective, multi-centre, randomised controlled trial is required for evaluating the efficacy of any compound on modifying the trajectory of stroke-like episodes.

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