Abstract
Purpose Seizure is a well-recognized complication of both remote and acute ischemic strokes. Predictors of seizure recurrence and epilepsy in patients with ischemic stroke who develop acute symptomatic seizures (ASyS) on continuous electroencephalography (cEEG) have not been well studied. Methods We present a five-year retrospective study of acute and remote ischemic stroke patients who developed ASyS on cEEG. We then identified risk factors for the development of seizure recurrence. Results Sixty-five patients with ischemic stroke and ASyS were identified and reviewed. All ASyS were noted to be nonconvulsive seizures. Clinical recurrence of seizures was identified in 19 of these patients (29.2%) at follow-up. Rate of seizure recurrence was higher in remote ischemic stroke patients (84.2%), compared to acute ischemic stroke patients (15.8%, p = 0.0116, OR 0.17, 95% CI 0.049–0.65). Sharp waves/spikes on follow-up EEG significantly correlated with seizure recurrence (p = 0.006, OR 0, 95% CI 0–0.3926). Patients discharged on ≥3 antiepileptic drugs (AEDs) were at a higher risk of having seizure recurrence (p = 0.0015, OR 0.05, 95% CI 0.0089–0.37). Conclusion We identified risk factors of seizure recurrence in patients with ASyS as remote ischemic stroke, requiring multiple AEDs, and the presence of sharp waves on follow-up EEG. This study highlights the usefulness of cEEG in evaluating patients with acute or remote strokes.
Highlights
Seizures are well-recognized complications of ischemic strokes, especially in older adults [1, 2]
We present a veyear retrospective study of ischemic stroke patients who had acute symptomatic seizure (ASyS) during hospitalization, identifying risk factors for the development of seizure recurrence
All patients with continuous electroencephalography (cEEG) seizures following either acute (≤14 days) or remote (>14 days) ischemic stroke (IS) were identi ed, and only patients who had follow-up encounters in the electronic medical record were included in this review. cEEG at our center is generally placed on patients either due to an alteration in mental status or due to clinical suspicion for seizures
Summary
Seizures are well-recognized complications of ischemic strokes, especially in older adults [1, 2]. E risk of subsequent development of epilepsy is highest in patients with remote ischemic stroke (i.e., >2 weeks from ischemic stroke onset) [5,6,7,8]. A challenge to this treatment strategy is identifying seizures in stroke patients without clinical signs. This furthers the importance of continuous electroencephalography (cEEG) to diagnose electrographic nonconvulsive seizures [14]. Predictors of seizure recurrence in ischemic stroke patients who have ASyS are not well characterized. We present a veyear retrospective study of ischemic stroke patients who had ASyS during hospitalization, identifying risk factors for the development of seizure recurrence
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