Clinical predictors of seizure recurrence after the first post-ischemic stroke seizure

Abstract

BackgroundThe number of patients suffering post-stroke seizure after ischemic stroke (PSSi) is quite considerable, especially because ischemic stroke is more prevalent than hemorrhage in the general population. This study aimed to determine the predicting factors for seizure recurrence in ischemic stroke survivors and develop a clinical scoring system for the prediction of risks for seizure recurrence after the first PSSi.MethodsWe reviewed 3792 ischemic stroke patients from the Ewha Stroke Registry. A total of 124 (3.3 %) patients who experienced PSSi were recruited (mean follow-up for 44.4 months). Medical records concerning the etiology, functional disability, seizure onset latency from stroke, type of seizure, electroencephalography (EEG), and neuroimaging findings were statistically analyzed to derive a seizure recurrence risk scoring system.ResultsSeizures recurred in 35.4 % (17/48) of early PSSi patients (≤1 week since stroke onset) and 48.7 % (37/76) of late PSSi (>1 week) patients. Atrial fibrillation, large sized, and cortical stroke lesion were more common in late onset PSSi compared to those in early onset PSSi (p < 0.05). Seizure recurrence tended to be more prevalent in early PSSi patients with male gender, atrial fibrillation or cortical stroke lesion, severe functional disability, and partial seizures. Seizure recurrence in late PSSi group was more common in patients of young age (≤65 years old), male gender, large lesion size, and partial seizure type. The validity of seizure recurrence risk score in the early PSSi group was better when evaluating based on gender, atrial fibrillation, cortical lesion, functional disability, and partial seizure type, with sensitivity of 70.6 % and specificity of 71.0 %.ConclusionsOur study characterized the high risk group for seizure recurrence in patients with the first PSSi. PSSi patients with high risk score of seizure recurrence had a greater chance of developing epilepsy later. Therefore, they should be considered for further treatment such as antiepileptic drug medication in clinical practice.

Risk factors for post-stroke seizure recurrence after the first episode

“…In this study, younger age was a predictor of late onset PSS recurrence, consistent with several previous reports [14,15,20,27]. It was suggested that compared with the elderly, younger patients were more likely to develop large cortical infarcts, rather than small vessel disease [27], and needed a higher dose of AED because of better drug clearance [28].…”

“…The risk factors for PSS recurrence have been reported to be late onset of seizure, stroke severity, age less than 74 years, valproic acid monotherapy, and the presence of convulsions on admission [9,13,14]. One report showed that young age and male gender were associated with seizure recurrence after the first post-ischemic stroke seizure [15]. Another report showed that a relatively large volume of hematoma was a predictor of seizure recurrence after the first post-hemorrhagic stroke seizure [16].…”

Vinpocetine and Ischemic Stroke

“…Kim et al reported that PIS predisposes for early and late onset epilepsy which called post-stroke seizure (PSS) due to the disturbances in the neuronal metabolic homeostasis, reactive gliosis, glutamate release and neuronal hyper-excitability [52]. Recently, Garza-Morales et al, found that VPN is effective as an adjuvant therapy in the management of epilepsy, it reduces seizure frequency by 50% in a dose of 2 mg/kg/day as compared with placebo [53].…”

Early seizures after ischemic stroke: focus on thrombolysis

“…Only 13 studies reported risk factors of late/recurrent seizures and epilepsy. 19,22,23,28,37,[39][40][41][42][52][53][54] Severe and cortical strokes were the most important risk factors; ESs were associated with recurrent seizures/epilepsy in two studies 37,39 ( Table 2).…”