Risk factors for a first epileptic seizure after stroke: a case control study.
BACKGROUND
The risk of seizures increases after stroke, but not all risk factors are known. We aimed to identify factors that increase the risk of a first seizure after a stroke.


METHODS
Multicenter case-control study of 161 patients with a first seizure after stroke (105 provoked/acute and 56 unprovoked/remote symptomatic) matched to 279 hospital stroke controls by center, gender, age and timing of stroke.


RESULTS
The risk of first seizure (odds ratio (OR), 95% confidence limits (CL)) was 3.6 (2.4-5.5) for cortical involvement, 2.5 (1.2-5.3) for multiple CT-scan lesions, 2.4 (1.5-3.9) for supratentorial lesions, 2.4 (1.6-3.7) for prior lesions on CT-scan, 2.1 (1.1-4.7) for family history of seizures, 2.0 (1.1-3.6) for use of epileptogenic drugs, 1.7 (1.0-2.9) for large lesions, 1.6 (1.0-2.8) for hemorrhagic lesions, and 1.4 (1.0-2.2) for cortical atrophy. After multivariate analysis, including all the factors significant in univariate analysis, the strongest independent predictor of a first seizure was cortical involvement (OR 3.3; 95% CL=2.1-5.0), followed by prior lesions (2.2; 1.4-3.4) and hemorrhagic stroke (1.8, 1.0-3.2). The multivariate analysis model for remote symptomatic seizures included cortical involvement, large size, and prior lesions; the model for acute seizures included cortical involvement, alcohol consumption >50 g/day, hemorrhagic stroke, and prior lesions on CT-scan.


CONCLUSIONS
Cortical involvement, the presence of prior lesions on CT-scan, and hemorrhagic lesion are the most important risk factors for a first-ever seizure after stroke.
Leone
Maurizio A
MA
Clinica Neurologica, Ospedale Maggiore della Carità, Novara, Italy. maurizio.leone@maggioreosp.novara.it
Tonini
Maria C
MC
Bogliun
Graziella
G
Gionco
Maurizio
M
Tassinari
Tiziana
T
Bottacchi
Edo
E
Beghi
Ettore
E
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001284:Atrophy; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed