Predictive factors for the development of epilepsy after ischemic stroke |
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| Affiliation: | 1. Centro Integral de Neurología Vascular, Fleni. Ciudad Autónoma de Buenos Aires, Argentina;2. Centro de Rehabilitación de Adultos – CR Escobar, Fleni. Buenos Aires, Argentina;3. Centro Integral de Epilepsia y Unidad de Video EEG, Fleni. Ciudad Autónoma de Buenos Aires, Argentina;4. Servicio de Diagnóstico por Imágenes, Fleni. Ciudad Autónoma de Buenos Aires, Argentina;1. Department of Neurology, University of Florida, Gainesville, FL, United States;2. Department of Neurology, Harborview Medical Center, University of Washington School of Medicine, Box 359775, 325 Ninth Avenue, Seattle, WA 98104, United States;3. Department of Biostatistics, University of Washington, Seattle, WA, United States;4. Department of Radiology, University of North Carolina, Chapel Hill, NC, United States;5. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada;1. Stroke Program, University of Michigan Medical School, Ann Arbor, United States;2. Department of Epidemiology, University of Michigan School of Public Health, United States;3. Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, United States;1. Division of Neurocritical Care, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA;2. Department of Neurology, Brigham and Women''s Hospital, Boston, MA, USA;3. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA;4. Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA;5. Department of Pharmacy, Brigham and Women''s Hospital, Boston, MA, USA;6. Renal Division, Brigham and Women''s Hospital, Boston, MA, USA;7. Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand;8. Department of Neurosurgery, Brigham and Women''s Hospital, Boston, MA, USA;1. Department of Public Health, Chengdu Medical College, Sichuan 610500, China;2. Department of Neurology, Chengdu Second People''s Hospital, Sichuan610041,China;3. Department of Physiology, Chengdu Medical College, Sichuan 610500, China;1. Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA;2. Department of Neurology, Georgetown University School of Medicine, Washington, D.C., USA;3. Department of Cardiology, Yale University, New Haven, Connecticut, USA;4. Molecular Neuropharmacological Unit, National Institute of Neurological Diseases and Stroke, NINDS, Bethesda, Maryland, USA;5. Department of Neurosurgery, University of Connecticut, Hartford, Connecticut, USA;6. Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA;7. Department of Critical Care, Springfield Clinic, Springfield, Illinois, USA;8. Department of Neurology, University of Maryland School of Medicine, Baltimore, USA;1. Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1101, Japan;2. Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan;3. Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan;4. Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan;5. Department of Neurosurgery, Fujita Health University School of Medicine, Aichi, Japan |
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| Abstract: | ObjectivesIschemic stroke is one of the most common causes of epilepsy in adults. The incidence of post-stroke epilepsy (PSE) is approximately 7%. Risk factors are higher stroke severity, cortical localization, higher National Institute of Health Stroke Scale (NIHSS) upon admission and acute symptomatic seizures. We analyzed the predictive factors of PSE development in our population.Materials and methodsRetrospective observational cohort of adult patients (age ≥ 18 years) with ischemic stroke assessed between January 2012 and June 2020. Patients with personal history of epilepsy and potentially epileptogenic structural injury other than acute or chronic stroke were excluded. Demographic, clinical and imaging variables were evaluated in a multivariate analysis for independent risk factors associated with PSE.ResultsMedical records of 1586 stroke patients were reviewed, 691 met the inclusion criteria and had at least one year of follow-up. Of them, 428 (61.9%) were males. During follow-up, 6.2% had diagnosis of PSE (42/691) with a higher frequency of: previous ischemic stroke, higher NIHSS upon admission, treatment with rt-PA, higher Fazekas scale grade, cortical involvement, hemorrhagic transformation, acute symptomatic seizures, longer hospitalization and higher modified Rankin Scale (mRS) at discharge compared to the group without PSE. In a multivariate analysis, acute symptomatic seizures (OR=3.22, p: 0.033), cortical involvement (OR=0.274, p < 0.05), Fazekas scale score (OR=0.519, p < 0.05) and mRS at discharge (OR=1.33, p: 0.043) were independent risk factors.ConclusionsThe variables related to higher risk of PSE were similar to those reported in the literature, highlighting the importance of neuroimaging findings, acute symptomatic seizures during hospitalization and neurological deficit at discharge. The data obtained will serve as the basis for construction of predictive models, allowing to individualize PSE probability in our population. |
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