Poststroke epilepsy: Epidemiology, pathophysiology and management

Drugs and Aging

Volumn 21, Issue 10, 2004, Pages 639-653

  Ferro, José M ^a   Pinto, Francisco ^a  

^a HOSPITAL DE SANTA MARIA   (Portugal)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ADRENERGIC RECEPTOR STIMULATING AGENT; ANTICOAGULANT AGENT; ANTIDEPRESSANT AGENT; ANTIHISTAMINIC AGENT; BACLOFEN; CARBAMAZEPINE; DIAZEPAM; ETIRACETAM; FOSPHENYTOIN SODIUM; GABAPENTIN; IMIPENEM; LAMOTRIGINE; LORAZEPAM; NEUROLEPTIC AGENT; OXCARBAZEPINE; PHENYTOIN; THEOPHYLLINE; TIAGABINE; TOPIRAMATE; TRAMADOL; VALPROIC ACID; ZONISAMIDE;

ANGIOPLASTY; BEHAVIOR DISORDER; BRAIN VEIN; CAROTID ENDARTERECTOMY; CEREBRAL SINUS THROMBOSIS; CLINICAL TRIAL; CONFUSION; CORRELATION ANALYSIS; DIAGNOSTIC TEST; DRUG ABSORPTION; DRUG BIOAVAILABILITY; DRUG CHOICE; DRUG CONTRAINDICATION; DRUG COST; DRUG DOSE REGIMEN; DRUG HALF LIFE; DRUG PROTEIN BINDING; DRUG SAFETY; DRUG TOLERABILITY; ELECTROENCEPHALOGRAM; EPILEPSY; EPILEPTIC STATE; HUMAN; KIDNEY CLEARANCE; LIVER METABOLISM; META ANALYSIS; MOTOR DYSFUNCTION; NEUROLOGIC EXAMINATION; PATHOGENESIS; PATIENT COMPLIANCE; PRIORITY JOURNAL; REVIEW; RISK ASSESSMENT; SIDE EFFECT; SUBARACHNOID HEMORRHAGE; TREATMENT FAILURE;

ANTICONVULSANTS; CEREBRAL INFARCTION; CEREBROVASCULAR ACCIDENT; DRUG ADMINISTRATION SCHEDULE; HUMANS; META-ANALYSIS; MULTICENTER STUDIES; RANDOMIZED CONTROLLED TRIALS; SEIZURES;

EID: 4344660489     PISSN: 1170229X     EISSN: None     Source Type: Journal    
DOI: 10.2165/00002512-200421100-00003     Document Type: Review

References (119)

1. Li X, Breteler MM, de Bruyne MC, et al. Vascular determinants of epilepsy: the Rotterdam study. Epilepsia 1997; 38: 1216-20
2. Schreiner A, Pohlmann-Eden B, Schwartz A, et al. Epileptic seizures in subcortical vascular encephalopathy. J Neurol Sci 1995; 130: 171-7
3. Pohlmann-Eden B, Hoch DB, Cochius JI, et al. Stroke and epilepsy: critical review of the literature. Part I: epidemiology and risk factors. Cerebrovasc Dis 1996; 6: 332-8
4. Pohlmann-Eden B, Cochius JI, Hoch DB, et al. Stroke and epilepsy: critical review of the literature. Part II: risk factors, pathophysiology and overlap syndromes. Cerebrovasc Dis 1997; 7: 2-9
5. Abbott AL, Bladin CF, Donnan GA. Seizures and stroke. In: Bogousslasky J, Caplan L, editors. Stroke syndromes. 2nd ed. Cambridge: Cambridge University Press, 2001: 182-91
6. Silverman IE, Restrepo L, Mathews GC. Poststroke seizures. Arch Neurol 2002; 59: 195-202
7. Ossemann M. Mise au point: crises épileptiques et epilepsies d'origine vasculaire: caractéristiques cliniques, é lectroencéphalographiques et scannographiques. Rev Neurol (Paris) 2002; 158: 256-9
8. Piepgras DG, Sundt Jr TM, Ragoowansi AT, et al. Seizure outcome in patients with surgically treated cerebral arteriovenous malformations. J Neurosurg 1993; 78: 5-11
9. Yeh HS, Tew Jr JM, Gartner M. Seizure control after surgery on cerebral arteriovenous malformations. J Neurosurg 1998; 78: 12-8
10. Turjman F, Massoud TF, Sayre JW, et al. Epilepsy associated with cerebral arteriovenous malformations: a multivariate analysis of angioarchitectural characteristics. AJNR Am J Neuroradiol 1995; 16: 345-50
11. Kurita H, Kawamoto S, Suzuki I, et al. Control of epilepsy associated with cerebral arteriovenous malformations after radiosurgery. J Neurol Neurosurg Psychiatry 1998; 65: 648-55
12. Hofmeister C, Stapf C, Hartmann A, et al. Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation. Stroke 2000; 31: 1307-10
13. Giroud M, Lemesle M, Madinier G, et al. Stroke in children under 16 years of age: clinical and etiological difference with adults. Acta Neurol Scand 1997; 96: 401-6
14. De Schryver EL, Kappelle LJ, Jennekens-Schinkel A, et al. Prognosis of ischemic stroke in childhood: a long-term follow-up study. Dev Med Child Neurol 2000 May; 42 (5): 313-8
15. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiological studies on epilepsy. Epilepsia 1993; 34: 592-6
16. Davenport RJ, Dennis MS, Wellwood I, et al. Complications after acute stroke. Stroke 1996; 27: 415-26
17. Awada A, Omojola MF, Obeid T. Late epileptic seizures after cerebral infarction. Acta Neurol Scand 1999; 99: 265-8
18. Yanagihara T, Piepgras DG, Klass DW. Repetitive involuntary movement associated with episodic cerebral ischemia. Ann Neurol 1985; 18: 244-50
19. Baquis GD, Pessin MS, Scott RM. Limb shaking: a carotid TIA. Stroke 1985; 16: 444-8
20. Saposnik G, Caplan LR. Convulsive-like movements in brainstem stroke. Arch Neurol 2001; 58: 654-7
21. Hart RJ, Byer JA, Slaughter JR, et al. Occurrence and implications of seizures in subarachnoid haemorrhage due to ruptured intracranial aneurysms. Neurosurgery 1981; 8: 417-21
22. Lee H, Lerner A. Transient inhibitory seizures mimicking crescendo TIAs. Neurology 1990; 40: 165-6
23. Kaplan PW. Focal seizures resembling transient ischemic attacks due to subclinical ischemia. Cerebrovasc Dis 1993; 3: 241-3
24. Giroud M, Gras P, Fayolle H, et al. Early seizures after acute stroke: a study of 1640 cases. Epilepsia 1994; 35: 959-64
25. So EL, Annegers JF, Hauser WA, et al. Population-based study of seizure disorders after cerebral infarction. Neurology 1996; 46: 350-5
26. Burn J, Dennis M, Bamford J, et al. Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. BMJ 1997; 315: 1582-7
27. Labovitz DL, Hauser WA, Sacco RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology 2001; 57: 200-6
28. Selim M, Kumar S, Fink J, et al. Seizure at stroke onset: should it be a absolute contraindication to thrombolysis? Cerebrovasc Dis 2002; 14: 54-7
29. Ottman R, Huaser WA, Stallone L. Semistructured interview for seizure classification: agreement with physicians' diagnoses. Epilepsia 1990; 31: 110-5
30. Reutens DC, Howell RA, Gebert KE, et al. Validation of a questionnaire for clinical seizure diagnosis. Epilepsia 1992; 33: 1065-71
31. Ottman R, Lee JH, Hauser WA, et al. Reliability of seizure classification using a semistructured interview. Neurology 1993; 43: 2526-30
32. Bodensteiner JB, Brownsworth RD, Knapik JR, et al. Interobserver variability in the ILAE classification of seizures in childhood. Epilepsia 1988; 29: 123-8
33. Kilpatrick CJ, Davis SM, Tress BM, et al. Epileptic seizures in acute stroke. Arch Neurol 1990; 47: 157-60
34. Davalos A, De Cendra E, Molins M, et al. Epileptic seizures at the onset of stroke. Cerebrovasc Dis 1992; 2: 327-31
35. Lanceman ME, Golimstok A, Norscini J, et al. Risk factors for developing seizures after stroke. Epilesia 1993; 34: 141-3
36. Lo YK, Yiu CH, Hu HH, et al. Frequency and characteristics of early seizures in Chinese acute stroke. Acta Neurol Scand 1994; 90: 83-5
37. Arboix A, García-Eroles L, Massons JB, et al. Predictive factors of early seizures after acute cerebrovascular disease. Stroke 1997; 28: 1590-4
38. Reith J, Jørgensen HS, Nakayama H, et al. Seizures in acute stroke: predictors and prognostic significance. The Copenhagen Stroke Study. Stroke 1997; 28: 1585-9
39. Marrero C, Díez E, Iváñez V, et al. Crisis epilépticas précoces y tardías tras isquemia cerebral hemisférica. Rev Neurol 1998; 27: 676-81
40. Berges S, Moulin T, Berger E, et al. Seizures and epilepsy following strokes: recurrence factors. Eur Neurol 2000; 43: 3-8
41. Heuts-van Raak L, Lodder J, Kessels F. Late seizures following a first symptomatic brain infarct are related to large infarcts involving the posterior area around the lateral sulcus. Seizure 1996; 5: 185-94
42. Berger AR, Lipton RB, Lesser ML, et al. Early seizures following intracerebral haemorrhage: implications for therapy. Neurology 1988; 38: 1363-5
43. Faught E, Peters A, Bartolucci A, et al. Seizures after primary intracerebral haemorrhage. Neurology 1989; 39: 1089-93
44. Sung CY, Chu NS. Epileptic seizures in intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 1989; 52: 1273-6
45. Weisberg LA, Shamsnia N, Elliott D. Seizures caused by non-traumatic parenchymal brain haemorrhage. Neurology 1991; 41: 1197-9
46. Melo TP, Ferro JM, Falcão F. Early and late epileptic seizures in intracerebral hemorrhage [abstract]. Cerebrovasc Dis 1999; 9: 88
47. Bladin CF, Alexandrov AV, Bellavance A, et al., for the Seizures after Stroke Study Group. Seizures after stroke: a prospective multicentre study. Arch Neurol 2000; 57: 1617-22
48. Fukujima MM, Cardeal JO. Características das crise epilépticas após acidente vascular cerebral isquêmico. Arq Neuropsiquiatr 1997; 55: 741-8
49. Dhanuka AK, Misra UK, Kalita J. Seizures after stroke: a prospective clinical study. Neurol India 2001; 49: 33-6
50. Cheung C-M, Tsoi T-H, Au-Yeung M, et al. Epileptic seizure after stroke in Chinese patients. J Neurol 2003; 250: 839-43
51. Bentes C, Pimentel J, Ferro J. Epileptic seizures following subcortical infarcts. Cerebrovasc Dis 2001; 12: 331-4
52. Giroud M, Raymond D. Role of associated cortical lesions in motor partial seizures and lenticulostriate infarcts. Epilepsia 1995; 36: 465-70
53. Arboix A, Comes E, Massons J, et al. Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease. Neurology 1996; 47: 1429-35
54. Lossius MI, Ronning OM, Mowinckel P, et al. Incidence and predictors for post-stroke epilepsy: a prospective controlled trial: the Akershus Stroke Study. Eur J Neurol 2002; 9: 365-8
55. Mohr JP, Caplan LR, Melski JW, et al. The Harvard cooperative stroke registry: a prospective registry. Neurology 1978; 28: 754-62
56. Pohlmann-Eden B, Schreiner A, Hornung T. Predictive value and morphological pattern of cerebrovascular disease lesions in patients presenting with a first 'unprovoked seizure' [abstract]. Ann Neurol 1998; 44: 468
57. Pohlmann-Eden B, Fatar M, Hennerici M. The preserved cortical island sigh is highly predictive of postischemic seizures. Cerebrovasc Dis 2001; 12: 282
58. Rumbach L, Sablot D, Berger E, et al. Status epilepticus in stroke: report on a hospital-based stroke cohort. Neurology 2000; 54: 350-4
59. Afsar N, Kaya D, Aktan S, et al. Stroke and status epilepticus: stroke type, type of status epilepticus, and prognosis. Seizure 2003; 12: 23-7
60. Velioglu SK, Özmenoglu M, Boz C, et al. Status epilepticus after stroke. Stroke 2001; 32: 1169-72
61. Kim J-A, Chung JI, Yoon PH, et al. Transient MR signal changes in patients with generalised tonicoclonic seizure or status epilepticus: periictal diffusion-weighted imaging. AJNR Am J Neuroradiol 2001; 22: 1149-60
62. Wieshmann UC, Symms MR, Shorvon SD. Diffusion changes in status epilepticus. Lancet 1997; 350: 493-4
63. Waterhouse EJ, Vaughan JK, Barnes TY, et al. Synergistic effect of status epilepticus and ischemic brain injury on mortality. Epilepsy Res 1998; 29: 175-83
64. Rhoney DH, Tipps LB, Murry KR, et al. Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid haemorrhage. Neurology 2000; 55: 258-65
65. Pinto NA, Canhão P, Ferro JM. Seizures at the onset of subarachnoid haemorrhage. J Neurol 1996; 243: 161-4
66. Claassen J, Peery S, Kreiter KT, et al. Predictors and clinical impact of epilepsy after subarachnoid haemorrhage. Neurology 2003; 60: 208-14
67. Preter M, Tzourio CH, Ameri A, et al. Long-term prognosis in cerebral venous thrombosis: follow-up of 77 patients. Stroke 1996; 27: 243-6
68. Ferro JM, Correia M, Rosas MJ, et al., for the Cerebral Venous Thrombosis Portuguese Collaborative Study Group (VENOPORT). Seizures in cerebral vein and dural sinus thrombosis. Cerebrovasc Dis 2003: 15: 78-83
69. Lamy C, Domigo V, Semah F, et al. Early and late seizures after cryptogenic ischaemic stroke in young adults. Neurology 2003; 60: 400-4
70. Nielsen TG, Sillesen H, Schroeder TV. Seizures following carotid endarterectomy in patients with severely compromised cerebral circulation. Eur J Vasc Endovasc Surg 1995; 9: 53-7
71. Naylor AR, Evans J, Thompson MM, et al. Seizures after carotid endarterectomy: hyperperfusion, dysautoregulation or hypertensive encephalopathy? Eur J Vasc Endovasc Surg 2003; 26: 39-44
72. Ho DSW, Wang Y, Chui M, et al. Epileptic seizures attributed to cerebral hyperperfusion after percutaneous transluminal angioplasty and stenting of the internal carotid artery. Cerebrovasc Dis 2000; 10: 374-9
73. Bogousslavsky J, Martin R, Regli F, et al. Persistent worsening of stroke sequelae after delayed seizures. Ann Neurol 1992; 19: 105-11
74. Vespa PM, O'Phelan K, Shah M, et al. Acute seizures after intracerebral haemorrhage: a factor in progressive midline shift and outcome. Neurology 2003; 60: 1441-6
75. Garzia Marciani M, Santone G, Sancesario G, et al. Epileptic activity following 10 minute cerebral ischemia in Mongolian gerbils: an electrophysiological study. Neurosci Lett 1990; 112: 48-53
76. Bullock R, Zauner A, Woodward J, et al. Massive persistent release of excitatory amino acids following human occlusive stroke. Stroke 1995; 26: 2187-219
77. Davalos A, Castillo J, Serena J, et al. Duration of glutamate release after acute ischemic stroke. Stroke 1997; 28: 708-10
78. Kessler KR, Schnitzler A, Classen J, et al. Reduced inhibition within primary motor cortex in patients with poststroke focal motor seizures. Neurology 2002; 59: 1028-33
79. Hossman KA. Viability thresholds and the penumbra of focal ischemia. Ann Neurol 1994; 36: 557-65
80. Gupta SR, Naheedy MH, Elias D, et al. Postinfarction seizures: a clinical study. Stroke 1988; 19: 1477-81
81. Engel JR. Seizures and epilepsy. Philadelphia (PA): Davis, 1989
82. Köhr G. Genetically determined changes of glutamate receptors: implications for epilepsy. In: Wolf P, editor. Epileptic seizures and syndromes. London: Libbey, 1944: 175-81
83. Kraemer DLA, Pizzonia JH. Vascular lesions as a cause of epilepsy. In: Kotagel P, Lüders HO, editors. The epilepsies: etiologies and preventions. San Diego (CA): Academic Press, 1999: 385-90
84. Pohlmann-Eden B, Hoch D, Cochius J, et al. Significance of subclinical epileptiform processes after stroke: results of a preliminary prospective study [abstract]. Epilepsia 1995; 36: 588
85. Neufelfd MY, Vishnevskaya S, Treves TA, et al. Periodic lateralized epileptiform discharges (PLEDs) following stroke are associated with metabolic abnormalities. Electroencephalogr Clin Neurophysiol 1997; 102: 295-8
86. Holmes GL. The electroencephalogram as a predictor of seizures following cerebral infarction. Clin Electroencephalogr 1980; 11: 83-6
87. Garzon E, Fernandes RMF, Sakamoto AC. Analysis of clinical characteristics and risk factors for mortality in human status epilepticus. Seizure 2003; 12: 337-45
88. DeLorenzo RJ, Waterhouse EJ, Towne AR, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 1998; 39: 833-40
89. Sacquegna T, de Carolis P, Crisci M, et al. Status epilepticus in acute ischemic stroke. Ital J Neurol Sci 1995; 16: 453-7
90. Labovitz DL, Hauser WA. Preventing stroke-related seizures: when should anticonvulsant drug be started? Neurology 2003; 60: 365-6
91. Sirven JI, Sperling M, Wingerchuk DM. Early versus late antiepileptic drug withdrawal for people with epilepsy in remission. (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
92. Gilad R, Lampl Y, Eschel M, et al. Antiepileptic treatment in patients with early postischemic stroke seizures: a retrospective study. Cerebrovasc Dis 2001; 12: 39-43
93. Schierhout G, Roberts I. Anti-epileptic drugs for preventing seizures following acute traumatic brain injury (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
94. Tudur Smith C, Marson AG, Clough HE, et al. Carbamazepine versus phenytoin monotherapy for epilepsy (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
95. Tudur Smith C, Marson AG, Williamson PR. Phenytoin versus valproate monotherapy for partial onset seizures and generalized onset tonic-clonic seizures (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
96. Marson AG, Williamson PR, Hutton JL, et al. Carbamazepine versus valproate monotherapy for epilepsy (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
97. Alvarez-Sabín J, Montaner J, Padró L, et al. Gabapentin in late-onset poststroke seizures. Neurology 2002; 59: 1991-3
98. Ramaratnam S, Marson AG, Baker GA. Lamotrigine add-on for drug-resistant partial epilepsy (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
99. Chaisewikul R, Privitera MD, Hutton JL, et al. Levetiracetam add-on for drug-resistant localization related (partial) epilepsy (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
100. Chadwick DW, Marson AG. Zonisamide add-on for drug-resistant partial epilepsy (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cocnrane Collaboration; issue 3. Oxford: Update Software, 2003
101. Castillo S, Schmidt DB, White S. Oxcarbazepine add-on for drug-resistant partial epilepsy (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
102. Pereira J, Marson, AG, Hutton JL. Tiagabine add-on for drug-resistant partial epilepsy (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
103. Jette NJ, Marson AG, Hutton JL. Topiramate add-on for drug-resistant partial epilepsy (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2003
104. Brodie MJ, Overstall PW, Giorgi L. Multicentre, double-blind, randomised comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. The UK Lamotrigine Elderly Study Group. Epilepsy Res 1999; 37: 81-7
105. Ferrendelli JA, Frenck J, Leppik I, et al. Use of levetiracetam in a population of patients aged 65 years and older: a subset analysis of the KEEPER trial. Epilepsy Behav 2003; 4: 702-9
106. Marson AG, Kadir ZA, Chadwick DW. New antiepileptic drugs: a systematic review of their efficacy and tolerability. BMJ 1996; 313: 1169-74
107. Marson AG, Kadir ZA, Hutton JL, et al. The new antiepileptic drugs: a systematic review of their efficacy and tolerability. Epilepsia 1997; 38: 859-80
108. Marson AG, Hutton JL, Leach JP, et al. Leviracetam, oxcarbazepine, remacemide and zonisamide for drug resistant localization-related epilepsy: a systematic review. Epilepsy Res 2001; 46: 259-70
109. Patsalos P, Perucca E. Clinically important interactions in epilepsy: general features and interactions between antiepileptic drugs. Lancet Neurol 2003; 2: 347-56
110. Lowenstein DH. Treatment options for status epilepticus. Curr Opin Pharmacol 2003; 3: 6-11
111. Manno EM. New management strategies in the treatment of status epilepticus. Mayo Clin Proc 2003; 78: 508-18
112. Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 2001; 345: 631-7
113. Ulvi H, Yoldas T, Mungen B, et al. Continuous infusion of midazolam in the treatment of refractory generalized convulsive status epilepticus. Neurol Sci 2002; 23: 177-82
114. Sinha S, Naritoku D. Intravenous valproate is well tolerated in unstable patients with status epilepticus. Neurology 2000; 55: 722-4
115. Towne AR, Garnett LK, Waterhouse EJ, et al. The use of topiramate in refractory status epilepticus. Neurology 2003; 60: 332-4
116. Stockley IH. Anticonvulsant drug interactions. In: Stockley IH, editor. Drug interactions. 5th ed. London: Pharmaceutical Press, 1999: 273-330
117. Adams Jr HP, Adams RJ, Brott T, et al. Stroke Council of the American Stroke Association. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke 2003; 34: 1056-83
118. Broderick JP, Adams Jr HP, Barsan W, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1999; 30: 905-15
119. Hack W, Kaste M, Bogousslavsky J, et al. European Stroke Initiative recommendations for stroke management: update 2003. Cerebrovasc Dis 2003; 16 (4): 311-37