title: Seizure Outcomes and Predictors of Recurrent Post-Stroke Seizure: A Retrospective Observational Cohort Study.
abstract: BACKGROUND
  Seizure is a common complication after stroke (termed "post-stroke seizure," PSS). Although many studies have assessed outcomes and risk factors of PSS, no reliable predictors are currently available to determine PSS recurrence. We compared baseline clinical characteristics and post-stroke treatment regimens between recurrent and non-recurrent PSS patients to identify factors predictive of recurrence.
  
  
  METHODS
  Consecutive PSS patients admitted to our stroke center between January 2011 and July 2013 were monitored until February 2014 (median 357 days; IQR, 160-552) and retrospectively evaluated for baseline clinical characteristics and PSS recurrence. Cumulative recurrence rates at 90, 180, and 360 days post-stroke were estimated by Kaplan-Meier analysis. Independent predictors of recurrent PSS were identified by Cox proportional-hazards analysis.
  
  
  RESULTS
  A total of 104 patients (71 men; mean age, 72.1 ± 11.2 years) were analyzed. PSS recurred in 31 patients (30%) during the follow-up. Factors significantly associated with PSS recurrence by log-rank analysis included previous PSS, valproic acid (VPA) monotherapy, polytherapy with antiepileptic drugs (AEDs), frontal cortical lesion, and higher modified Rankin Scale score at discharge (all p < 0.05). Independent predictors of recurrent PSS were age <74 years (HR 2.38, 95% CI 1.02-5.90), VPA monotherapy (HR 3.86, 95% CI 1.30-12.62), and convulsions on admission (HR 3.87, 95% CI 1.35-12.76).
  
  
  CONCLUSIONS
  Approximately one-third of PSS patients experienced seizure recurrence within one year. The predictors of recurrent PSS were younger age, presence of convulsions and VPA monotherapy. Our findings should be interpreted cautiously in countries where monotherapy with second-generation AEDs has been approved because this study was conducted while second-generation AEDs had not been officially approved for monotherapy in Japan.
authors: Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Tomotaka
authors: T
authors: Tanaka
authors: Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Hiroshi
authors: H
authors: Yamagami
authors: Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Masafumi
authors: M
authors: Ihara
authors: Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Rie
authors: R
authors: Motoyama
authors: Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Kazuki
authors: K
authors: Fukuma
authors: Department of Stroke and Cerebrovascular Diseases, Division of Cerebrovascular Medicine, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Tetsuya
authors: T
authors: Miyagi
authors: Department of Stroke and Cerebrovascular Diseases, Division of Cerebrovascular Medicine, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Kazutaka
authors: K
authors: Nishimura
authors: Department of Stroke and Cerebrovascular Diseases, Division of Cerebrovascular Medicine, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Kazunori
authors: K
authors: Toyoda
authors: Department of Stroke and Cerebrovascular Diseases, Division of Neurology, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Kazuyuki
authors: K
authors: Nagatsuka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D020521:Stroke / Q000150:complications*