Incidence of seizures and epilepsy in post-stroke by nuu18388

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									Author: Margaret Stafford, MD                                                          12/6/2005
Reviewer: David Thom, MD, PhD


              Incidence of seizures and epilepsy in post-stroke patients
Bottom line:
   • The 1-year risk of seizures in post-stroke patients is 20% in patients with hemorrhagic stroke
      and 14% in patients with ischemic stroke.
   • Patients with late seizures (occurring >2 weeks after stroke) carry a much higher risk of
      developing epilepsy.

Clinical Question:
    • In patients who have had a stroke and no prior history of seizures, what is the incidence of
       seizures?

Evidence:
   • Bladin et al. performed a prospective cohort study of stroke patients (Seizures After Stroke
      Study)
    • Population: all patients hospitalized with acute stroke at a group of university teaching
       hospitals over 34 months; n=1897.
           o Excluded patients with brainstem or cerebellar stroke, subarachnoid or subdural
               hematomas, AVMs, and past history of seizures.
    • Time-to-event curves showed that 1-year risk of seizures post-stroke was 20% in patients
       with hemorrhagic stroke, and 14% in patients with ischemic stroke (p=0.02).
    • 60% of seizures were early-onset (within 2 weeks of stroke) and 40% were late-onset (> 2
       weeks).
    • Recurrent seizures (epilepsy) were seen in 2.5% of all patients, in 28% of all patients with a
       seizure, and in 55% of patients with late onset seizure.
    • There were no significant differences in age, gender, or risk factors for stroke of seizure
       between seizure and non-seizure groups
    • In patients with ischemic stroke, significant risk factors for seizures were cortical location of
       infarction and level of disability. In patients with hemorrhagic stroke, only cortical location
       was significant to predict seizures.
    • Patients with late-onset (> 2 weeks post-stroke) seizures were at greater risk of developing
       epilepsy than patients with early onset-seizures(hazard ratio = 23.77, p<0.001).

Comments
   • The patients in this study were admitted to tertiary care facilities (university hospitals with
     stroke units). It is possible that such patients may be more likely to have post-stroke
     seizures than stroke patients in the general population

Citations

Bladin CF, Alexandrov AV, Bellavance AB, et al. Seizures after stroke: a prospective multicenter
study. Arch Neurology 2000;57:1617-1622.

								
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