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

Abstract

<ns5:p> <ns5:bold>Background:</ns5:bold> 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. </ns5:p> <ns5:p> <ns5:bold>Methods:</ns5:bold> 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. </ns5:p> <ns5:p> <ns5:bold>Results:</ns5:bold> 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. </ns5:p> <ns5:p> <ns5:bold>Conclusions:</ns5:bold> 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. </ns5:p>