Seizures after stroke: a prospective multicenter study.

BACKGROUND Studies of seizures after stroke have largely been retrospective, with small patient numbers and limited statistical analysis. Much of the doctrine about seizures after stroke is not evidenced based. OBJECTIVE To determine the incidence, outcome, and risk factors for seizures after stroke. DESIGN International, multicenter, prospective, analytic inception cohort study conducted for 34 months. PATIENTS AND SETTING There were 2021 consecutive patients with acute stroke admitted to university teaching hospitals with established stroke units. After exclusion of 124 patients with previous epilepsy or without computed tomographic diagnosis, 1897 were available for analysis. Mean follow-up was 9 months. MAIN OUTCOME MEASURES Occurrence of 1 or more seizures after stroke, stroke disability, and death after stroke. RESULTS Seizures occurred in 168 (8.9%) of 1897 patients with stroke (28 [10.6%] of 265 with hemorrhagic and 140 [8.6%] of 1632 with ischemic stroke). On Kaplan-Meier survival analysis, patients with hemorrhagic stroke were at significantly greater risk of seizures (P =.002), with an almost 2-fold increase in risk of seizure after stroke (hazard ratio [HR], 1.85; 95% confidence interval [CI], 1.26-2.73; P =.002). On multivariate analysis, risk factors for seizures after ischemic stroke were cortical location of infarction (HR, 2.09; 95% CI, 1. 19-3.68; P<.01) and stroke disability (HR, 2.10; 95% CI, 1.16-3.82; P<.02). The only risk factor for seizures after hemorrhagic stroke was cortical location (HR, 3.16; 95% CI, 1.35-7.40; P<.008). Recurrent seizures (epilepsy) occurred in 47 (2.5%) of 1897 patients. Late onset of the first seizure was an independent risk factor for epilepsy after ischemic stroke (HR, 12.37; 95% CI, 4.74-32.32; P<. 001) but not after hemorrhagic stroke. CONCLUSIONS Seizures occur more commonly with hemorrhagic stroke than with ischemic stroke. Only a small minority later develop epilepsy. Patients with a disabling cortical infarct or a cortical hemorrhage are more likely to have seizures after stroke; those with late-onset seizures are at greater risk of epilepsy.

[1]  P. Sandercock,et al.  Epileptic seizures after a first stroke: the Oxfordshire community stroke project , 1997, BMJ.

[2]  T. Olsen,et al.  Seizures in acute stroke: predictors and prognostic significance. The Copenhagen Stroke Study. , 1997, Stroke.

[3]  A. Arboix,et al.  Predictive factors of early seizures after acute cerebrovascular disease. , 1997, Stroke.

[4]  W. Hauser,et al.  Population-based study of seizure disorders after cerebral infarction , 1996, Neurology.

[5]  M. Giroud,et al.  Early Seizures After Acute Stroke: A Study of 1,640 Cases , 1994, Epilepsia.

[6]  S. Mayer,et al.  Neurologic deterioration in noncomatose patients with supratentorial intracerebral hemorrhage , 1994, Neurology.

[7]  Willmore Lj.  Post-Traumatic Seizures , 1993 .

[8]  A. Alexandrov,et al.  Cerebral Perfusion Index , 1993, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[9]  D. Hasan,et al.  Amount of Blood on Computed Tomography as an Independent Predictor After Aneurysm Rupture , 1993, Stroke.

[10]  W. Hauser,et al.  Incidence of Epilepsy and Unprovoked Seizures in Rochester, Minnesota: 1935–1984 , 1993, Epilepsia.

[11]  L. Willmore,et al.  Post-traumatic seizures. , 1993, Neurologic clinics.

[12]  K Wienhard,et al.  Progressive Derangement of Periinfarct Viable Tissue in Ischemic Stroke , 1992, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[13]  A. Dávalos,et al.  Epileptic Seizures at the Onset of Stroke , 1992 .

[14]  L. Weisberg,et al.  Seizures caused by nontraumatic parenchymal brain hemorrhages , 1991, Neurology.

[15]  S M Davis,et al.  Epileptic seizures in acute stroke. , 1990, Archives of neurology.

[16]  Daniel B Hier,et al.  Infarcts with a cardiac source of embolism in the NINCDS Stroke Data Bank , 1990, Neurology.

[17]  N. Chu,et al.  Epileptic seizures in intracerebral haemorrhage. , 1989, Journal of neurology, neurosurgery, and psychiatry.

[18]  E. Faught,et al.  Seizures after primary intracerebral hemorrhage , 1989, Neurology.

[19]  V Hachinski,et al.  The Canadian Neurological Scale , 1989, Neurology.

[20]  A. Dávalos,et al.  The frequency, characteristics and prognosis of epileptic seizures at the onset of stroke. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[21]  R. Lipton,et al.  Early seizures following intracerebral hemorrhage , 1988, Neurology.

[22]  S. Shorvon,et al.  Clinically Unsuspected Cerebral Infarction Revealed by Computed Tomography Scanning in Late Onset Epilepsy , 1988, Epilepsia.

[23]  R. Cipolle,et al.  Can embolic stroke be diagnosed on the basis of neurologic clinical criteria? , 1987, Archives of neurology.

[24]  R Côté,et al.  The Canadian Neurological Scale: a preliminary study in acute stroke. , 1986, Stroke.

[25]  H. Lüders,et al.  Epileptic Seizures Due to Thrombotic and Embolic Cerebrovascular Disease in Older Patients , 1985, Epilepsia.

[26]  Y. L. Yu,et al.  Evidence of vascular disease from CT scanning in late onset epilepsy. , 1984, Journal of neurology, neurosurgery, and psychiatry.

[27]  C. Fisher.  Lacunar strokes and infarcts , 1982, Neurology.

[28]  P. Kellaway,et al.  Proposal for Revised Clinical and Electroencephalographic Classification of Epileptic Seizures , 1981, Epilepsia.

[29]  C M Chee,et al.  Seizure disorders. , 1980, The Nursing clinics of North America.

[30]  B. Jennett.  Posttraumatic epilepsy. , 1979, Advances in neurology.

[31]  J. Meyer,et al.  Cerebral Embolization: Prospective Clinical Analysis of 42 Cases , 1971, Stroke.