J Korean Neurol Assoc.  2015 May;33(2):89-96. 10.17340/jkna.2015.2.3.

Acute Symptomatic Seizures in Patients with Acute Ischemic Stroke: Incidence and Predictive Factors

Affiliations
  • 1Department of Neurology, Yeungnam University College of Medicine, Daegu, Korea. sejinmayo@ynu.ac.kr

Abstract

BACKGROUND
The aim of this study was to establish the incidence, predictive factors, characteristics, and clinical outcomes of acute symptomatic seizures (ASS) after acute ischemic stroke (AIS).
METHODS
In total, 2,528 consecutive patients with first-ever AIS were included. Patients with a history of epilepsy or provoked seizures due to tumor, head trauma, brain surgery, or high fever were excluded. Onset seizure (OS) and ASS were defined as seizures occurring within 24 hours and 7 days after AIS, respectively. The incidence of ASS, type of seizures, presence of late unprovoked seizure (LUS), MRI, and electroencephalogram were analyzed.
RESULTS
ASS and OS occurred in 23 patients (0.9%) and 15 patients (0.6%), respectively; 20 of the patients with ASS (87.0%) had partial seizures and 4 (17.4%) developed status epilepticus. The incidence rates of ASS were 1.3%, 0.3%, and 0.2% in AIS caused by large-artery atherosclerosis, small-vessel occlusion, and cardioembolism, respectively. Of the 23 patients with ASS, the cortex was involved in 19 (82.6%), 16 patients (69.6%) had medium-sized to large lesions, the anterior circulation territory was involved in 21 patients (91.3%), and 4 patients (17.4%) developed MRI-confirmed hemorrhagic transformation of the lesions. Epileptiform discharges were observed in 9 (45%) of the 20 patients with ASS. Three of the 23 patients with ASS (13.0%) developed LUS.
CONCLUSIONS
The incidence of ASS was 0.9% and was highest in the large-artery atherosclerosis group. The development of ASS was significantly associated with cortical involvement, medium-sized to large lesions, and lesions in the anterior circulation territory. Three of 23 patients (13%) developed LUS.

Keyword

Acute symptomatic seizure; Onset seizure; Post-stroke seizure; Acute ischemic stroke; Cerebral infarction

MeSH Terms

Atherosclerosis
Brain
Cerebral Infarction
Craniocerebral Trauma
Electroencephalography
Epilepsy
Equidae
Fever
Humans
Incidence*
Magnetic Resonance Imaging
Seizures*
Status Epilepticus
Stroke*
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