Complications of Acute Stroke and the Occurrence of Early Seizures

Abstract

Background: Seizures are common neurological consequences of stroke. Although a number of factors including stroke severity on admission, cortical involvement, and stroke subtype have been consistently associated with post-stroke seizures, the effect that medical and neurological complications of stroke, occurring in the very acute phase, might have on such a risk has never been adequately explored. In the present study we aimed at determining the extent to which complications within the first week of stroke influence the risk of early seizures (ES). Methods: Data of consecutive patients with first-ever acute stroke included in the Brescia Stroke Registry were analyzed. ES (≤7 days) were recorded and correlated with demographic data, disease characteristics, risk factors, and prespecified medical and neurological stroke complications in a multivariate path analysis model. Results: 516 patients with first-ever acute stroke were eligible for inclusion in the present study. Of them, 436 patients had ischemic stroke (IS) [64 (14.6%) with hemorrhagic transformation (HT)] and 80 had intracerebral hemorrhage (ICH). Twenty patients (3.9%) developed ES. Patients with ES had a higher burden of complications compared with those without (30 vs. 4.2%, for patients with >6 complications). Lesion type, stroke complications, and lesion site were directly related to the risk of seizure occurrence (OR, 0.24; 95% CI, 0.07-0.80 for IS vs. ICH; OR, 1.57; 95% CI, 1.21-2.01 for any increase of 1 in the number of complications; OR, 0.15; 95% CI, 0.04-0.56 for subcortical lesions vs. cortical lesions). Complications appeared also to mediate the indirect effect of lesion type on the occurrence of ES (OR, 0.75; 95% CI, 0.60-0.94). No significant difference on the risk of ES was observed when HT and ICH were compared. The total effect of lesion type was 0.25 × 0.75 = 0.18, corresponding to (1-0.18) = 82% lower risk of ES for IS as compared to ICH. Conclusion: Although major determinants of ES are nonmodifiable, preventable and treatable medical and neurologic complications within the first week of stroke increase the risk of ES and mediate the effect of established predictors on the propensity to post-stroke epilepsy. Future epidemiologic studies aimed at investigating post-stroke seizures should include precise information on these complications.

Association between Seizures and Outcomes among Intracerebral Hemorrhage Patients: The China National Stroke Registry

“…Meanwhile, in-hospital complications and performance measures also were recorded and taken into account. Similar to previous studies, 17,22 seizure patients with ICH had more severe stroke and in-hospital complications such as pneumonia in our study, which may further worsen clinical outcomes. 18,19 This phenomenon could explain the higher utilization of supporting interventions and mortality in patients with seizures.…”

Does treatment with t-PA increase the risk of developing epilepsy after stroke?

“…This finding was unexpected as PSE has been reported to be less frequent in patients with brain stem stroke [39]. Acute 'infection' during the inpatient stay appeared to increase the risk of PSE significantly confirming previous studies demonstrating a higher incidence of early seizures in stroke patients with other medical or neurological complications [42,43], although this issue is rarely studied. Pneumonia was reported to be associated with seizures during the hospital stay [44], and another study which differentiated between early-and late-onset seizures described a significantly higher incidence of late-onset seizures in patients with a preceding infection [17].…”

Are Early Seizures Predictive of Epilepsy after a Stroke? Results of a Population-Based Study

“…The different incidence rates found among studies are also due to the different timing used to define early seizures (ES), varying between 24 h [8,9,10], 2 weeks [11,12,13,14,15] and 4 weeks [16]. In most recent studies, however, the 7-day time frame has been used as it represents the time interval needed in order to define acute symptomatic seizures [17,18,19]. All seizures occurring after this period are defined as late seizures (LS).…”