Seizures after stroke: a prospective multicenter study.
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.


METHODS
International, multicenter, prospective, analytic inception cohort study conducted for 34 months.


METHODS
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.


METHODS
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.
Bladin
C F
CF
Department of Neuroscience, Box Hill Hospital, Nelson Road, Box Hill 3128, Melbourne, Australia.
Alexandrov
A V
AV
Bellavance
A
A
Bornstein
N
N
Chambers
B
B
Coté
R
R
Lebrun
L
L
Pirisi
A
A
Norris
J W
JW
D000368:Aged; D000704:Analysis of Variance; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000150:complications; D002544:Cerebral Infarction / Q000150:complications; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D020521:Stroke / Q000150:complications* / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome