title: Complications of acute stroke and the occurrence of early seizures.
abstract: BACKGROUND
  Seizures are common neurological consequences of stroke. Although a number of factors including stroke severity on admission, cortical involvement, and stroke subtype have been consistently associated with post-stroke seizures, the effect that medical and neurological complications of stroke, occurring in the very acute phase, might have on such a risk has never been adequately explored. In the present study we aimed at determining the extent to which complications within the first week of stroke influence the risk of early seizures (ES).
  
  
  METHODS
  Data of consecutive patients with first-ever acute stroke included in the Brescia Stroke Registry were analyzed. ES (≤7 days) were recorded and correlated with demographic data, disease characteristics, risk factors, and prespecified medical and neurological stroke complications in a multivariate path analysis model.
  
  
  RESULTS
  516 patients with first-ever acute stroke were eligible for inclusion in the present study. Of them, 436 patients had ischemic stroke (IS) [64 (14.6%) with hemorrhagic transformation (HT)] and 80 had intracerebral hemorrhage (ICH). Twenty patients (3.9%) developed ES. Patients with ES had a higher burden of complications compared with those without (30 vs. 4.2%, for patients with >6 complications). Lesion type, stroke complications, and lesion site were directly related to the risk of seizure occurrence (OR, 0.24; 95% CI, 0.07-0.80 for IS vs. ICH; OR, 1.57; 95% CI, 1.21-2.01 for any increase of 1 in the number of complications; OR, 0.15; 95% CI, 0.04-0.56 for subcortical lesions vs. cortical lesions). Complications appeared also to mediate the indirect effect of lesion type on the occurrence of ES (OR, 0.75; 95% CI, 0.60-0.94). No significant difference on the risk of ES was observed when HT and ICH were compared. The total effect of lesion type was 0.25 × 0.75 = 0.18, corresponding to (1-0.18) = 82% lower risk of ES for IS as compared to ICH.
  
  
  CONCLUSIONS
  Although major determinants of ES are nonmodifiable, preventable and treatable medical and neurologic complications within the first week of stroke increase the risk of ES and mediate the effect of established predictors on the propensity to post-stroke epilepsy. Future epidemiologic studies aimed at investigating post-stroke seizures should include precise information on these complications.
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italia. alessandro.pezzini @ med.unibs.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzini
authors.forename: Mario
authors.initials: M
authors.lastname: Grassi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Del Zotto
authors.forename: Alessia
authors.initials: A
authors.lastname: Giossi
authors.forename: Irene
authors.initials: I
authors.lastname: Volonghi
authors.forename: Paolo
authors.initials: P
authors.lastname: Costa
authors.forename: Loris
authors.initials: L
authors.lastname: Poli
authors.forename: Andrea
authors.initials: A
authors.lastname: Morotti
authors.forename: Massimo
authors.initials: M
authors.lastname: Gamba
authors.forename: Marco
authors.initials: M
authors.lastname: Ritelli
authors.forename: Marina
authors.initials: M
authors.lastname: Colombi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D049292:Leukoaraiosis / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology / Q000209:etiology*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000145:classification / Q000150:complications* / Q000453:epidemiology; D013997:Time Factors