Background: Both early seizure (ES) and late seizure (LS) are common complications after stroke. However, clinical characteristics, treatments and recurrences after ES/LS remain unclarified.
Methods: We enrolled the patients with first-ever post-stroke seizures between July 2010 and June 2014, and followed up until June 2015. Seizures were classified into ES (within one week after stroke) and LS (the second week or later). We compared baseline clinical characteristics, status epilepticus, surgery (removal of hematoma, ventricular drainage), neurological deterioration by index stroke (defined as an increase of the NIHSS score by one or more between the baseline and at hospital discharge), and duration of antiepileptic drug (AED) therapy between two groups. We also investigated factors (patients’ background and treatment of seizure) that determined the seizure recurrence after discharge.
Results: Clinical data were collected for 153 patients (82 men; age, 73.7±12.3, 73 intracerebral hemorrhage and 80 ischemic stroke). ES occurred in 62 and LS in 91 patients. Patients with LS more commonly received surgery (ES 3% vs. LS 17%, p=0.008) and more commonly had neurological deterioration (ES 71% vs. LS 87%, p=0.02) than those with ES. LS received AED therapy more frequently both during hospitalization (ES 71% vs. LS 94%, p=0.0003) and after hospitalization (ES 49% vs. LS 92%, p<0.0001). Seizure recurred in 56 patients (14 ES, 41 LS) after discharge during a median follow-up of 29 months. In a multivariate Cox proportional-hazards model of these patients, independent predictors of recurrence included status epilepticus (HR 2.28,95% CI 1.08-5.17) and LS (HR 3.62,95% CI 1.11-10.09)(p<0.05, respectively).
Conclusion: Status epilepticus and LS were risk factors of seizure recurrence in first-ever post-stroke seizure.