Characteristics and Outcomes of Patients with Seizures according to the Time of Onset in Relation to Stroke

Abstract

Background/Aim: Although most late-onset seizures (LS) appear within 2 years after stroke, some of them occur later and their characteristics are unknown. The aim of this study was to compare the characteristics of patients with very-late-onset seizures (VLS) to those with early-onset seizures (ES) and those with LS. Patients: The study group consisted of 204 patients with stroke-related seizures (29 ES, 128 LS and 47 VLS). Results: Intracranial haemorrhage was a more frequent cause of ES than of LS and no cause at all of VLS. On the other hand, 25% of the VLS were related to lacunar strokes. Status epilepticus occurred in 20.7% of the ES, in 11.7% of the LS and in 2.1% of the VLS patients. Seizure recurrences were 13.8% in the ES, 54.7% in the LS and 34.0% in the VLS group. Neurological impairment, at stroke onset, and the degree of disability were more severe in patients with ES compared to those with LS and were very mild in the VLS group. The EEG findings as a whole did not show significant differences between the three groups, although a normal EEG was more frequent in the VLS group. Conclusion: VLS occur in patients with minor ischaemic strokes with good recovery and benign disease course.

Status Epilepticus in Stroke Patients

“…Similar to previous studies [6, 7], we can demonstrate a trend that SE occurs more frequently at stroke onset. On the other hand, seizure recurrence is not more common in patients with SE than in those with OS.…”

“…As early-onset seizures occur mainly in patients with a high NIHS score [7] and SE is linked to a high NIHS score, SE at the onset of a severe stroke must be more frequent than could be demonstrated in this study. A recent study has demonstrated that electric epileptic activity in patients with a severe acute stroke occurs more frequently than previously suspected [28].…”

“…However, as some ‘late-onset’ seizures were due to recurrent infarcts [10] and 25% of the late-onset seizures appeared >2 years after the stroke [7], the stroke-related seizures were subdivided in those of early-, late- and very late-onset and in those due to recurrent strokes [2]. …”

“…SE in patients with stroke-related seizures is found to have an incidence as high as 14 up to 27% in some studies [4, 5]. It is more frequently observed at onset of the stroke than as a late complication [6, 7]. It occurs in patients with extensive cortical involvement due to cerebral infarction as well as due to a lobar hematoma [8,9,10,11].…”

Cognitive Impairment and Seizures in Patients with Lacunar Strokes

“…While patients with a partial anterior circulation syndrome as the clinical presentation [10] and large cortical infarcts in the temporal and parietal lobes [11, 12] have a high risk of developing early- as well as late-onset seizures, this is not the case in patients with lacunar strokes [9]. In the latter, the seizures occur generally very late after the onset of the stroke [13]. They generally have a benign course with a low recurrence rate and without the occurrence of status epilepticus [14].…”