The occurrence of seizures after ischemic stroke does not influence long-term mortality; a 26-year follow-up study

A P Aldenkamp,R J Van Oostenbrugge,J H Van Tuijl,R P W Rouhl,E P M Van Raak

doi:10.1007/s00415-018-8907-7

Abstract

ObjectiveEpileptic seizures are a common complication after stroke. The relation between occurrence of seizures after stroke and long-term mortality remains elusive. We aimed to assess whether seizures in an early or late phase after ischemic stroke are an independent determinant of long-term mortality.MethodsWe prospectively included and followed 444 ischemic stroke patients with a first-ever supratentorial brain infarct for at least 2 years after their stroke regarding the occurrence of seizures. The final follow-up for mortality is from April 2015 (follow-up duration 24.5–27.8 years, mean 26.0 years, SD 0.9 years). We compared patients with early-onset seizures with all seizure-free patients, whereas the patients with late-onset seizures were compared with the 1-week survivors without any seizures. We used Cox-regression analyses to correct for possible confounding factors.ResultsKaplan–Meier analysis showed significantly higher mortality for the patients with early-onset seizures (p = 0.002) but after correction for known risk factors for (long term) mortality early-onset seizures had no independent influence on long-term mortality (HR 1.09; 95% CI 0.64–1.85). In patients with late-onset seizures, no significant influence from late-onset seizures on long-term mortality was found (univariate p = 0.717; multivariate HR 0.81; 95% CI 0.54–1.20).ConclusionBoth early-onset and late-onset seizures do not influence long-term mortality after ischemic stroke.

Highlights

Epileptic seizures are a common complication after stroke the risk to develop seizures varies, depending on variables such as stroke type, stroke severity, and cortical involvement [1,2,3,4,5,6,7]
For this study on post-stroke seizures and longterm mortality, we excluded 7 patients with a history of epilepsy, 17 with a rare cause of stroke and 7 of whom it was not possible to retrieve if and when they died, because they were not registered in the BRP anymore due to emigration
0.72 unknown) had a significant relation with mortality at all time points, whereas diabetes mellitus and male gender only played a role in the longer follow-up duration (Table 5). We showed that both ES and LS did not influence long-term mortality after ischemic stroke

Summary

Introduction

Epileptic seizures are a common complication after stroke the risk to develop seizures varies, depending on variables such as stroke type (hemorrhagic vs. ischemic), stroke severity, and cortical involvement [1,2,3,4,5,6,7]. Seizures occurring after stoke are divided in early-onset seizures (ES, incidence 3.3% of patients) and late-onset seizures (LS, incidence 18 in 1000 person years) depending on their time of occurrence, with a variable cut-off point in different studies between 24 h and 1 month post-stroke [2, 6, 8, 9]. According to the guidelines of the International League for Epilepsy (ILAE), in stroke patients with LS, epilepsy may be diagnosed after only one seizure [12]

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