Incidence and predictors of acute symptomatic seizures after stroke

• Published in: Neurology Vol. 77; no. 20; pp. 1785 - 1793
• Main Authors: BEGHI, E, D'ALESSANDRO, R, MATTANA, F, MUSOLINO, R, PROVINCIALI, L, SANTANGELO, M, SPECCHIO, L. M, ZACCARA, G, BERETTA, S, CONSOLI, D, CRESPI, V, DELAJ, L, GANDOLFO, C, GRECO, G, LA NEVE, A, MANFREDI, M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 15-11-2011
• Subjects: Acute Disease - epidemiology; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Hyperlipidemias - blood; Hyperlipidemias - complications; Incidence; Intracranial Hemorrhages - complications; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Predictive Value of Tests; Prospective Studies; Risk Factors; Seizures - complications; Seizures - epidemiology; Seizures - etiology; Stroke - complications; Stroke - diagnosis; Stroke - epidemiology; Time Factors; Vascular disease; Stroke; Nervous system diseases; Convulsion; Epilepsy; Central nervous system disease; Cardiovascular disease; Neurological disorder; Cerebrovascular disease; Cerebral disorder; Incidence
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/wnl.0b013e3182364878

To assess incidence and predictors of acute symptomatic seizures in a prospective cohort of patients with first stroke.
Patients with first stroke hospitalized in 31 Italian centers were recruited. Relevant demographic data, disease characteristics, and risk factors were collected. Acute symptomatic seizures (≤7 days) were recorded and correlated to age, gender, family history of epilepsy, and vascular risk factors.
A total of 714 patients (315 women, 399 men; age 27-97 years) were enrolled. A total of 609 (85.3%) had cerebral infarction (32 cerebral infarction with hemorrhagic transformation [CIHT]) and 105 (14.7%) primary intracerebral hemorrhage (PIH). A total of 141 (19.7%) had a large lesion (>3 cm) and 296 (41.5%) cortical involvement. Twelve patients reported family history of seizures. Forty-five patients (6.3%) presented acute symptomatic seizures, 24 with cerebral infarction (4.2%), 4 with CIHT (12.5%), and 17 (16.2%) with PIH. In multivariate analysis, compared to cerebral infarction, PIH carried the highest risk (odds ratio [OR] 7.2; 95% confidence interval [CI] 3.5-14.9) followed by CIHT (OR 2.7; 95% CI 0.8-9.6). Cortical involvement was a risk factor for PIH (OR 6.0; 95% CI 1.8-20.8) and for CI (OR 3.1; 95% CI 1.3-7.8). Hyperlipidemia (OR 0.2; 95% CI 0.03-0.8) was a protective factor for IPH.
The incidence of acute symptomatic seizures is the highest reported in patients with first stroke with prospective follow-up. Hemorrhagic stroke and cortical lesion were independent predictors of acute symptomatic seizures. Hyperlipidemia was a protective factor for hemorrhagic stroke.