Poststroke seizures in stroke rehabilitation patients.
The incidence, seizure type, location and type of stroke, and anticonvulsant medications, including adverse effects, were studied in a stroke rehabilitation population. Of 563 consecutive stroke patients admitted to the rehabilitation unit, 14 had a history of a seizure and were excluded from the primary study group. Of the remaining 549 stroke rehabilitation patients, 43 (7.8%) suffered a poststroke seizure (PSS). When only hemispheric patients were studied, the incidence of poststroke seizures rose to 43 of 460 (9.3%) as no brainstem stroke patients suffered seizures. The average age of the PSS patients was 55.4 years. The incidence of PSS in all stroke infarction patients was significantly smaller (22 of 450, 4.9%) when compared with hemorrhagic strokes (21 of 99, 21.2%) (P<.001). The incidence of PSS among hemispheric infarcts was 22 of 379 (5.8%) versus 21 of 81 (25.9%) of hemispheric hemorrhagic strokes (P<.001). Twenty-six PSS patients had primarily cortical involvement, 13 had both cortical and subcortical involvement, and only 4 had primarily subcortical involvement. Seizures occurred within the first 24 hours in 23.8% of stroke patients, 52.4% within the first week, in 66.7% within the first month, in 83.3% within the first 6 months, and in 88.1% within the first year. In the 43 patients with PSS, 19 (44.2%) were reportedly focal in nature, 12 (27.2%) were generalized, and 6 (14.0%) were focal with secondary generalization. Three (7.0%) were complex-partial seizures and 3(7.0%) were of an undetermined type. Of the 14 stroke rehabilitation patients excluded from the study group because of a prestroke seizure, 6 (42.9%) suffered a PSS in contrast to the 43 of 549 (7.8%) with no premorbid history of a seizure (P<.001).
Teasell
R W
RW
Department of Physical Medicine, London Health Sciences Centre, London, Ontario, Canada.
McRae
M P
MP
Wiebe
S
S