Highlights
- •The incidence of post-stroke epilepsy in our population was 6.2%.
- •.Acute symptomatic seizures, strokes with cortical involvement and higher mRS at discharge were independent risk factors.
- •In 90% of the patients, treatment with any antiseizure medication was started after the first seizure.
- •As stroke survivors increase, it is critical to obtain relevant data of post-stroke epilepsy diagnosis and treatment.
Abstract
Objectives
Ischemic stroke is one of the most common causes of epilepsy in adults. The incidence
of post-stroke epilepsy (PSE) is approximately 7%. Risk factors are higher stroke
severity, cortical localization, higher National Institute of Health Stroke Scale
(NIHSS) upon admission and acute symptomatic seizures. We analyzed the predictive
factors of PSE development in our population.
Materials and methods
Retrospective observational cohort of adult patients (age ≥ 18 years) with ischemic
stroke assessed between January 2012 and June 2020. Patients with personal history
of epilepsy and potentially epileptogenic structural injury other than acute or chronic
stroke were excluded. Demographic, clinical and imaging variables were evaluated in
a multivariate analysis for independent risk factors associated with PSE.
Results
Medical records of 1586 stroke patients were reviewed, 691 met the inclusion criteria
and had at least one year of follow-up. Of them, 428 (61.9%) were males. During follow-up,
6.2% had diagnosis of PSE (42/691) with a higher frequency of: previous ischemic stroke,
higher NIHSS upon admission, treatment with rt-PA, higher Fazekas scale grade, cortical
involvement, hemorrhagic transformation, acute symptomatic seizures, longer hospitalization
and higher modified Rankin Scale (mRS) at discharge compared to the group without
PSE. In a multivariate analysis, acute symptomatic seizures (OR=3.22, p: 0.033), cortical involvement (OR=0.274, p < 0.05), Fazekas scale score (OR=0.519, p < 0.05) and mRS at discharge (OR=1.33, p: 0.043) were independent risk factors.
Conclusions
The variables related to higher risk of PSE were similar to those reported in the
literature, highlighting the importance of neuroimaging findings, acute symptomatic
seizures during hospitalization and neurological deficit at discharge. The data obtained
will serve as the basis for construction of predictive models, allowing to individualize
PSE probability in our population.
Keywords
Abbreviations:
ASM (antiseizure medication), ASyS (acute symptomatic seizures), IS (ischemic stroke), mRS (modified Rankin Scale), NIHSS (National Institute of Health Stroke Scale), PSE (post-stroke epilepsy), TIA (transient ischemic attack)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 04, 2022
Accepted:
October 25,
2022
Received in revised form:
October 24,
2022
Received:
August 7,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106858
Copyright
© 2022 Elsevier Inc. All rights reserved.
