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.
Pages to are hidden for
"Incidence of seizures and epilepsy in post-stroke"Please download to view full document