Convulsive status epilepticus after ischemic stroke and intracerebral hemorrhage: frequency, predictors, and impact on outcome in a large administrative dataset

Abstract

Relatively little is known about the epidemiology of generalized convulsive status epilepticus (GCSE) in acute ischemic and hemorrhagic stroke. We examined the occurrence of GCSE in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) using a large discharge database. Data were derived from the Nationwide Inpatient Sample for the years 1994-2002. Using the appropriate ICD-9-CM codes, patients admitted through the emergency room with a diagnosis of AIS or ICH were selected for analysis. From these patients, those coded as having GCSE were identified. Multivariate logistic regression was performed using clinical elements available in the database to identify independent predictors of GCSE. The association between GCSE and various outcome measures was also assessed. The cohort included 718,531 hospitalizations with AIS and 102,763 with ICH. GCSE developed in 1,415 (0.2%) of the AIS cohort and 266 (0.3%) of the ICH cohort. For the AIS cohort, female sex, African American race, renal disease, alcohol abuse, sodium imbalance, and hemorrhagic transformation were associated with higher rates, while increasing age, hypertension, and diabetes mellitus were associated with lower rates of GCSE. For the ICH cohort, African American and Hispanic race, renal disease, coagulopathy, brain tumor, alcohol abuse, and sodium imbalance were associated with higher rates, while increasing age and hypertension were associated with lower rates of GCSE. GCSE was associated with higher rates of adverse outcomes. GCSE is a rare but serious complication in the setting of acute ischemic stroke and intracerebral hemorrhage.