title: Adverse effect of early epileptic seizures in patients receiving endovascular therapy for acute stroke.
abstract: OBJECTIVE
  The aim of this study was to analyze epileptic seizures and their impact on outcome in patients with stroke treated with endovascular therapy.
  
  
  METHODS
  From December 1992 to December 2010 we managed 805 patients with stroke with endovascular therapy. Epileptic seizures, bleeding complications, and 3-month outcomes were recorded prospectively. Outcomes of patients with early seizures (within 24 hours of stroke onset) and patients with late seizures (>24 hours after stroke) were compared with outcomes of seizure-free patients using uni- and multivariable statistics.
  
  
  RESULTS
  Forty-four of 805 patients (5.5%) had seizures between stroke onset and 3-month follow-up, 26 patients early and 18 late. Outcome of patients with late seizures and seizure-free patients was similar (P=0.144 and 0.807). Patients with early seizures had higher baseline National Institutes of Health Stroke Scale (P=0.023) and were younger (P=0.021) than seizure-free patients. Their mortality rate was 50% compared with 22.3% of the seizure free-patients (P=0.003), and less patients reached a favorable outcome (modified Rankin Scale 0-2): 15.4% and 46.8%, respectively (P=0.001). Early seizures independently predicted an unfavorable outcome (P=0.014; OR, 4.749; 95% CI, 0.376-3.914) and increased mortality (P=0.001; OR, 5.861; 95% CI, 0.770-2.947) in multiregression analysis. Patients with early seizures had a 1.6-fold higher risk for unfavorable outcome and a 2.2-fold higher risk for death compared with seizure-free patients.
  
  
  CONCLUSIONS
  Seizures within 24 hours of stroke onset were associated with worse outcome in patients with stroke undergoing endovascular therapy. Our findings confirm a need for trials for prophylactic anticonvulsive treatment in patients receiving endovascular therapy for acute stroke.
authors.affiliation: Departments of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.forename: Kaspar
authors.initials: K
authors.lastname: Schindler
authors.forename: Oliver
authors.initials: O
authors.lastname: Findling
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Mono
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.forename: Anja
authors.initials: A
authors.lastname: Weck
authors.forename: Aekaterini
authors.initials: A
authors.lastname: Galimanis
authors.forename: Caspar
authors.initials: C
authors.lastname: Brekenfeld
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology* / Q000401:mortality*; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors