Abstract
BackgroundAmong poststroke morbidities, poststroke epilepsy (PSE) has been identified as a significant clinical issue. Although middle cerebral artery (MCA) infarct is the most common type of stroke among all vascular territories, very few studies specifically focused on the risk factors leading to PSE in patients with MCA infarct.MethodsA population study in Taiwan has been conducted, linking the National Health Insurance Research Database and Hospital Stroke Registry, from 2001 to 2015 and 2006 to 2010, respectively. Patients were divided into MCA and non-MCA groups, and the diagnosis of incident epilepsy between the groups has been compared. The multivariable Cox proportional hazard model was used to identify the risk factors for developing PSE. The distribution of time to PSE was estimated using the Kaplan–Meier method.ResultsIn total, 1,838 patients were recruited, with 774 and 1,064 in the MCA and non-MCA groups, respectively. PSE incidence in the MCA group was 15.5% vs. 6.2% in the non-MCA group, with a hazard ratio of (95% CI) 2.06 (1.33–3.19). Factors significantly associated with PSE included atrial fibrillation, depression, National Institutes of Health Stroke Scale (NIHSS) scores of ≥ 16, and alert on arrival. For patients with MCA infarct, higher NIHSS and Glasgow coma scale scores, the presence of visual field defects and weakness, urination control impairment, and complications during hospitalization were associated with a higher risk for PSE development.ConclusionsThis study established the conditions leading to a higher risk of PSE and identified the important clinical risk factors in patients experiencing MCA infarct. Efforts to manage these risk factors may be important in preventing PSE in patients with MCA infarct.
Highlights
Advances in stroke treatment resulted in a dramatic reduction in stroke mortalities; the number of stroke survivors living with morbidities increased significantly
2,769 patients with ischemic stroke were identified from the Hospital Stroke Registry and were successfully linked to the National Health Insurance Research Database (NHIRD)
The overall middle cerebral artery (MCA) infarcts were associated with higher National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores, consistent with the initial presentation, where these patients were less likely to be alert on arrival
Summary
Advances in stroke treatment resulted in a dramatic reduction in stroke mortalities; the number of stroke survivors living with morbidities increased significantly. Among these morbidities, seizures and epilepsy are not uncommon, and PSE has been identified as a significant clinical issue among stroke survivors. Stroke is the most common cause of epilepsy in older adults and for patients aged more than 65 years, where PSE accounts for 30–50% of new-onset seizures [1]. Middle cerebral artery (MCA) infarct is the most common type of stroke among all vascular territories, very few studies focused on the risk factors leading to PSE in patients with MCA infarct
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