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Seizures After Stroke
A Prospective Multicenter Study
Christopher F. Bladin, MD, FRACP;
Andrei V. Alexandrov, MD;
André Bellavance, MD, PhD;
Natan Bornstein, MD;
Brian Chambers, MD;
Robert Coté, MD;
Louise Lebrun, MD;
Angelo Pirisi, MD;
John W. Norris, MD;
for the Seizures After Stroke Study Group
Arch Neurol. 2000;57:1617-1622.
Background Studies of seizures after stroke have largely been retrospective, with small patient numbers and limited statistical analysis. Much of the doctrine about seizures after stroke is not evidenced based.
Objective To determine the incidence, outcome, and risk factors for seizures after stroke.
Design International, multicenter, prospective, analytic inception cohort study conducted for 34 months.
Patients and Setting There were 2021 consecutive patients with acute stroke admitted to university teaching hospitals with established stroke units. After exclusion of 124 patients with previous epilepsy or without computed tomographic diagnosis, 1897 were available for analysis. Mean follow-up was 9 months.
Main Outcome Measures Occurrence of 1 or more seizures after stroke, stroke disability, and death after stroke.
Results Seizures occurred in 168 (8.9%) of 1897 patients with stroke (28 [10.6%] of 265 with hemorrhagic and 140 [8.6%] of 1632 with ischemic stroke). On Kaplan-Meier survival analysis, patients with hemorrhagic stroke were at significantly greater risk of seizures (P = .002), with an almost 2-fold increase in risk of seizure after stroke (hazard ratio [HR], 1.85; 95% confidence interval [CI], 1.26-2.73; P = .002). On multivariate analysis, risk factors for seizures after ischemic stroke were cortical location of infarction (HR, 2.09; 95% CI, 1.19-3.68; P<.01) and stroke disability (HR, 2.10; 95% CI, 1.16-3.82; P<.02). The only risk factor for seizures after hemorrhagic stroke was cortical location (HR, 3.16; 95% CI, 1.35-7.40; P<.008). Recurrent seizures (epilepsy) occurred in 47 (2.5%) of 1897 patients. Late onset of the first seizure was an independent risk factor for epilepsy after ischemic stroke (HR, 12.37; 95% CI, 4.74-32.32; P<.001) but not after hemorrhagic stroke.
Conclusions Seizures occur more commonly with hemorrhagic stroke than with ischemic stroke. Only a small minority later develop epilepsy. Patients with a disabling cortical infarct or a cortical hemorrhage are more likely to have seizures after stroke; those with late-onset seizures are at greater risk of epilepsy.
From the Stroke Research Unit, University of Toronto, Ontario (Drs Bladin, Alexandrov, and Norris); the Department of Neurology, Sherbrooke University, Montreal, Quebec (Dr Bellavance); the Department of Neurology, University of Tel Aviv, Tel Aviv, Israel (Dr Bornstein); the Department of Neurology, University of Melbourne, Melbourne, Australia (Dr Chambers); the Department of Neurology, McGill University, Montreal (Dr Cote); the Department of Neurology, University of Montreal, Montreal (Dr Lebrun); and the Department of Neurology, University of Sassari, Sassari, Italy (Dr Pirisi). Dr Bladin is now with the Department of Neurosciences, Box Hill Hospital, Melbourne, and Dr Alexandrov is now with the Department of Neurology, University of Texas–Houston Medical School.
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