Abstract
ObjectivesThis study aimed to determine whether post-stroke epilepsy (PSE) predicts mortality, and to describe the most prominent causes of death (COD) in a long-term follow-up after primary intracerebral hemorrhage (ICH). MethodsWe followed 3-month survivors of a population-based cohort of primary ICH patients in Northern Ostrobothnia, Finland, for a median of 8.8 years. Mortality and CODs were compared between those who developed PSE and those who did not. PSE was defined according to the ILAE guidelines. CODs were extracted from death certificates (Statistics Finland). ResultsOf 961 patients, 611 survived for 3 months. 409 (66.9%) had died by the end of the follow-up. Pneumonia was the only COD that was significantly more common among the patients with PSE (56% vs. 37% of deaths). In the multivariable models, PSE (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.06–1.87), age (HR 1.07, 95% CI 1.06–1.08), male sex (HR 1.35, 95% CI 1.09–1.67), dependency at 3 months (HR 1.52, 95% CI 1.24–1.88), non-subcortical ICH location (subcortical location HR 0.78, 95% CI 0.61−0.99), diabetes (HR 1.43, 95% CI 1.07–1.90) and cancer (HR 1.45, 95% CI 1.06–1.98) predicted death in the long-term follow-up. ConclusionPSE independently predicted higher late morality of ICH in our cohort. Pneumonia-related deaths were more common among the patients with PSE.
Highlights
The incidence of post-stroke epilepsy (PSE) is notable after stroke (2.6–6.4%) and even higher (4.3–13.5%) among patients with intrace rebral hemorrhage (ICH) (Chen et al, 2012; Rossi et al, 2013; Biffi et al, 2016; Lahti et al, 2017)
We already know that epilepsy in general is attributable to excess mortality, e.g. through the immediate effects of epileptic seizures, but little is known of its effect on overall survival in this group of patients (Thurman et al, 2017)
409 of the 611 3-month survivors had died by the end of 2016 (66.9%); 42 (7%) had died after 1 year of follow-up, 177 (29%) after 5 years and 318 (52%) after 10 years. 64 of 83 patients with PSE died altogether
Summary
The incidence of post-stroke epilepsy (PSE) is notable after stroke (2.6–6.4%) and even higher (4.3–13.5%) among patients with intrace rebral hemorrhage (ICH) (Chen et al, 2012; Rossi et al, 2013; Biffi et al, 2016; Lahti et al, 2017). We already know that epilepsy in general is attributable to excess mortality, e.g. through the immediate effects of epileptic seizures (e.g. traumatic events, status epilepticus), but little is known of its effect on overall survival in this group of patients (Thurman et al, 2017). It has previously been observed that, in patients with PSE after any type of stroke, the most common underlying CODs are diseases of the circulatory system, and mortality from these causes is higher than in the general population (Hansen et al, 2017). Our main hypothesis for this study was that PSE increases the risk of mortality in long-term follow-up. We aimed to determine the most common and relevant CODs in this population after a long-term followup focusing on cardiovascular disease, traumatic events and other likely CODs among the elderly
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