title: Post-stroke epilepsy in young adults: a long-term follow-up study.
abstract: BACKGROUND
  Little is known about the incidence and risk of seizures after stroke in young adults. Especially in the young seizures might dramatically influence prognosis and quality of life. We therefore investigated the long-term incidence and risk of post-stroke epilepsy in young adults with a transient ischemic attack (TIA), ischemic stroke (IS) or intracerebral hemorrhage (ICH).
  
  
  RESULTS
  We performed a prospective cohort study among 697 consecutive patients with a first-ever TIA, IS or ICH, aged 18-50 years, admitted to our hospital between 1-1-1980 till 1-11-2010. The occurrence of epilepsy was assessed by standardized questionnaires and verified by a neurologist. Cumulative risks were estimated with Kaplan-Meier analysis. Cox proportional hazard models were used to calculate relative risks. After mean follow-up of 9.1 years (SD 8.2), 79 (11.3%) patients developed post-stroke epilepsy and 39 patients (5.6%) developed epilepsy with recurrent seizures. Patients with an initial late seizure more often developed recurrent seizures than patients with an initial early seizure. Cumulative risk of epilepsy was 31%, 16% and 5% for patients with an ICH, IS and TIA respectively (Logrank test ICH and IS versus TIA p<0.001). Cumulative risk of epilepsy with recurrent seizures was 23%, 8% and 4% respectively (Logrank ICH versus IS p = 0.05, ICH versus TIA p<0.001, IS versus TIA p = 0.01). In addition a high NIHSS was a significant predictor of both epilepsy and epilepsy with recurrent seizures (HR 1.07, 95% CI 1.03-1.11 and 1.08, 95% CI 1.02-1.14).
  
  
  CONCLUSIONS
  Post-stroke epilepsy is much more common than previously thought. Especially patients with an ICH and a high NIHSS are at high risk. This calls upon the question whether a subgroup could be identified which benefits from the use of prophylactic antiepileptic medication. Future studies should be executed to investigate risk factors and the effect of post-stroke epilepsy on quality of life.
authors: Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, The Netherlands.
authors: Renate
authors: R
authors: Arntz
authors: Loes
authors: L
authors: Rutten-Jacobs
authors: Noortje
authors: N
authors: Maaijwee
authors: Hennie
authors: H
authors: Schoonderwaldt
authors: Lucille
authors: L
authors: Dorresteijn
authors: Ewoud
authors: E
authors: van Dijk
authors: Frank-Erik
authors: FE
authors: de Leeuw
mesh_terms: D000293:Adolescent; D000328:Adult; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000503:physiopathology; D004827:Epilepsy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012306:Risk; D012640:Seizures / Q000209:etiology* / Q000503:physiopathology; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D011795:Surveys and Questionnaires
references: Neurology. 2011 Nov 15;77(20):1785-93
references: 21975208
references: Cerebrovasc Dis. 2010;30(6):584-9
references: 20948201
references: Eur J Neurol. 2010 Jan;17(1):52-8
references: 19686350
references: Arch Neurol. 2000 Nov;57(11):1617-22
references: 11074794
references: Bull World Health Organ. 1976;54(5):541-53
references: 1088404
references: Stroke. 1975 Sep-Oct;6(5):564-616
references: 1179466
references: Stroke. 2000 Apr;31(4):858-62
references: 10753988
references: J Neurol. 2004 Dec;251(12):1507-14
references: 15645352
references: Stroke. 1989 Jul;20(7):864-70
references: 2749846
references: Stroke. 1997 Aug;28(8):1590-4
references: 9259754
references: Cerebrovasc Dis. 1998 Sep-Oct;8(5):296-302
references: 9712928
references: Neurology. 2011 Nov 15;77(20):1794-800
references: 21975203
references: BMC Neurol. 2011 Sep 20;11:109
references: 21933424
references: Epilepsy Behav. 2008 May;12(4):540-6
references: 18280210
references: Postgrad Med J. 2002 Apr;78(918):246-7
references: 11930031
references: Stroke. 1997 Aug;28(8):1585-9
references: 9259753
references: Neurology. 2003 Feb 11;60(3):400-4
references: 12578918
references: Neurology. 2002 Jul 9;59(1):26-33
references: 12105303
references: Prog Neurobiol. 1996 Feb;48(2):131-66
references: 8737441
references: Acta Neurol Scand. 2004 Aug;110(2):107-12
references: 15242418
references: Cerebrovasc Dis. 2009;27(5):509-18
references: 19372653
references: Epilepsia. 1993 Jul-Aug;34(4):592-6
references: 8330566
references: J Stroke Cerebrovasc Dis. 2005 Sep-Oct;14(5):210-4
references: 17904028
references: Epilepsia. 2008 Jun;49(6):974-81
references: 18248443
references: Neurology. 1996 Feb;46(2):350-5
references: 8614493
references: Ann Neurol. 2010 Nov;68(5):661-71
references: 21031581
references: Epilepsia. 2005 Apr;46(4):470-2
references: 15816939
references: Stroke. 1988 May;19(5):604-7
references: 3363593
references: Stroke. 1999 Aug;30(8):1534-7
references: 10436096
references: BMJ. 1997 Dec 13;315(7122):1582-7
references: 9437276
references: Neurology. 1996 Dec;47(6):1429-35
references: 8960722
references: Epilepsia. 2010 Apr;51(4):676-85
references: 20196795
references: Stroke. 2004 Jul;35(7):1769-75
references: 15166395
references: Epilepsia. 2005 Aug;46(8):1246-51
references: 16060935
references: J Neurol Neurosurg Psychiatry. 1991 Sep;54(9):793-802
references: 1955898
references: Epilepsia. 1997 Mar;38(3):266-70
references: 9070586
references: Neurology. 2001 Jul 24;57(2):200-6
references: 11468303