Predictors of Early Seizures after Stroke

Abstract

Prevalence and Predictors of Early Seizure and Status Epilepticus after First Stroke Labovitz DL, Allen Hauser W, Sacco RL Neurology 2001;57:200–206 Background Early seizure (ES) has been reported in 2 to 6% of strokes and is a predictor of recurrent seizures. Acute stroke has been reported to cause 22% of all cases of status epilepticus (SE) in adults. The determinants of ES and SE after stroke, however, are not well understood. Methods An incidence study was conducted to identify all cases of first stroke in adult residents of northern Manhattan. Cases of ES and SE within 7 days of stroke were identified through medical record review. Statistical analyses were performed by using univariate and multivariate logistic regression models. Results The cohort consisted of 904 patients; ES occurred in 37 (4.1%). The frequency of ES by stroke subtype and location was deep infarct in two (0.6%) of 356, lobar infarct in 20 (5.9%) of 341, deep intracerebral hemorrhage (ICH) in four (4.0%) of 101, lobar ICH in seven (14.3%) of 49, and subarachnoid hemorrhage in four (8.0%) of 50. SE occurred in 10 (1.1%) patients, representing 27.0% of patients with ES. Diabetes, hypertension, current smoking, alcohol use, age, gender, and race/ethnicity were not significant determinants of ES. In a subgroup of patients who had a National Institutes of Health (NIH) stroke scale (NIHSS) score recorded, NIHSS score was not an independent predictor of ES in multivariate analysis. After accounting for stroke severity, ES was not a predictor of 30-day case fatality. Conclusions Lesion location and stroke subtype are strong determinants of ES risk, even after adjusting for stroke severity. ES does not predict 30-day mortality. SE occurs in more than one fourth of patients with ES.