Abstract
BackgroundLittle is known about the incidence and risk of seizures after stroke in young adults. Especially in the young seizures might dramatically influence prognosis and quality of life. We therefore investigated the long-term incidence and risk of post-stroke epilepsy in young adults with a transient ischemic attack (TIA), ischemic stroke (IS) or intracerebral hemorrhage (ICH).Methods and FindingsWe performed a prospective cohort study among 697 consecutive patients with a first-ever TIA, IS or ICH, aged 18–50 years, admitted to our hospital between 1-1-1980 till 1-11-2010. The occurrence of epilepsy was assessed by standardized questionnaires and verified by a neurologist. Cumulative risks were estimated with Kaplan-Meier analysis. Cox proportional hazard models were used to calculate relative risks. After mean follow-up of 9.1 years (SD 8.2), 79 (11.3%) patients developed post-stroke epilepsy and 39 patients (5.6%) developed epilepsy with recurrent seizures. Patients with an initial late seizure more often developed recurrent seizures than patients with an initial early seizure. Cumulative risk of epilepsy was 31%, 16% and 5% for patients with an ICH, IS and TIA respectively (Logrank test ICH and IS versus TIA p<0.001). Cumulative risk of epilepsy with recurrent seizures was 23%, 8% and 4% respectively (Logrank ICH versus IS p = 0.05, ICH versus TIA p<0.001, IS versus TIA p = 0.01). In addition a high NIHSS was a significant predictor of both epilepsy and epilepsy with recurrent seizures (HR 1.07, 95% CI 1.03–1.11 and 1.08, 95% CI 1.02–1.14).ConclusionsPost-stroke epilepsy is much more common than previously thought. Especially patients with an ICH and a high NIHSS are at high risk. This calls upon the question whether a subgroup could be identified which benefits from the use of prophylactic antiepileptic medication. Future studies should be executed to investigate risk factors and the effect of post-stroke epilepsy on quality of life.
Highlights
The incidence of epilepsy after stroke in elderly ranges from 2% to 14%, depending on study population, stroke subtype and definitions of epilepsy [1,2,3,4,5,6,7]
Patients with an intracerebral hemorrhage (ICH) and a high NIHSS are at high risk
This calls upon the question whether a subgroup could be identified which benefits from the use of prophylactic antiepileptic medication
Summary
The incidence of epilepsy after stroke in elderly ranges from 2% to 14%, depending on study population, stroke subtype and definitions of epilepsy [1,2,3,4,5,6,7]. In young patients with a long life expectancy, seizures might have a dramatic influence on quality of life and disability due to its negative effect on stroke recovery and unpredictability. The only studies performed so far were usually small, had a short follow-up and different definitions of post-stroke epilepsy In addition those studies were not designed to investigate the risk of epilepsy and only included patients with an IS and not those with a TIA or ICH [3,12,13,14,15]. We investigated the long-term incidence and risk of post-stroke epilepsy in young adults with a transient ischemic attack (TIA), ischemic stroke (IS) or intracerebral hemorrhage (ICH)
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