Prevalence, risk factors and prognostic of seizures after ischemic stroke

Background: Epileptic seizure (ES) is a common and well-established complication associated with stroke. The presence of large ischemic areas and cortical lesions may lead to a higher risk of secondary ES. Although widely assessed, the occurrence of ES secondary to stroke has until unclear frequency, risk factors and functional impact. Objective: . To evaluate the predictive factors for a post-stroke ES, as well as its effects on the clinical outcome at hospital discharge. Methods: A total of 492 acute ischemic stroke (AIS) patients admitted to our stroke unit were included. Acute symptomatic seizures were defined as seizures that occur within the period of hospitalization without previous history of seizure with clinical and/or electroencephalographic evidence. Results: Thirty-eight patients (7.7%) had in-hospital clinical epileptic seizures. Seizures were significantly more common in patients with total anterior circulation syndrome. The NIHSS score (OR 1.07, 95% CI, p=0.03) and symptomatic hemorrhagic transformation (OR 3.53, 95% CI 1.38-8.99, p=0.01) were independent predictors for ES. We did not find an association between the occurrence of seizures and unfavorable outcomes at discharge (OR1.26, 95% CI 0.3-5.32, p=0.75). Conclusion: Patients with higher NIHSS on admission and who develop symptomatic hemorrhagic transformation are at risk of an in-hospital epileptic seizure. Acute symptomatic ES after AIS does not appear to be an independent predictor of an unfavorable outcome at discharge.