Abstract
Background: Seizures are a known complication of ischemic stroke. Some studies have reported a higher risk of post-stroke seizure with cardioembolic strokes, whereas others have not. The risk of post-stroke seizure for different stroke mechanisms is unclear. Objective: To compare different stroke etiologies and the risk of post-stroke seizure in a population-based study. Methods: Utilizing the Rochester Epidemiology Project medical records linkage system, we ascertained all first ischemic strokes occurring among Rochester, MN residents from 1990-1994, and followed the patients in the comprehensive medical record through March 2014 for occurrence of seizure. TOAST stroke subtype classification was determined by a consensus of cerebrovascular neurologists. New post-stroke seizure was identified by physician diagnosis and/or EEG report. Patients with a seizure before the index stroke were not included. Pre-morbid stroke risk factors were recorded. Associations between seizure after index ischemic stroke as outcome and other variables of interest were assessed using univariate logistic regression. Results: A total of 490 patients met inclusion criteria, with median follow-up of 6.5 years. Out of 490 patients, 35 had new onset seizures (7.1%). Median age was significantly lower at index stroke for patients with seizures (73 v. 77 years, p=0.017). The most common TOAST stroke subtype was cryptogenic (46.8%) followed by cardioembolic (24.9%). There was no significant difference in TOAST stroke subtypes between patients with post-stroke seizure and those without (p=0.35). There was also no difference between the two groups when comparing combined cardioembolic and large-vessel to small-vessel (p=0.28) or cryptogenic to small-vessel (p=0.9) mechanisms. There was also no difference in pre-morbid stroke risk factors between the two groups, including hypertension (p=0.22), total cholesterol (p=0.95), type 2 diabetes mellitus (p=0.13), tobacco use (p=0.27), atrial fibrillation (p=0.9), or previous myocardial infarction (p=0.67). Conclusion: This study suggests that the long-term risk of post-stroke seizures does not differ by ischemic stroke etiology.
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