Incidence and risk factors of post-stroke seizure among ischemic stroke patients

Emma M Federico; Kate Carroll; Margaret McGrath; Melanie Walker; Isaac Stafstrom; Erica Skinner; Margot Maraghe; Michael R Levitt

doi:10.1016/j.jstrokecerebrovasdis.2024.108072

Incidence and risk factors of post-stroke seizure among ischemic stroke patients

J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108072. doi: 10.1016/j.jstrokecerebrovasdis.2024.108072. Epub 2024 Oct 12.

Authors

Emma M Federico¹, Kate Carroll², Margaret McGrath², Melanie Walker³, Isaac Stafstrom⁴, Erica Skinner⁴, Margot Maraghe⁵, Michael R Levitt⁶

Affiliations

¹ Stroke & Applied NeuroScience Center, University of Washington, Seattle WA, USA; Stritch School of Medicine, Loyola University Chicago, Maywood IL, USA; Department of Neurological Surgery, University of Washington, Seattle WA, USA.
² Stroke & Applied NeuroScience Center, University of Washington, Seattle WA, USA; Department of Neurological Surgery, University of Washington, Seattle WA, USA.
³ Stroke & Applied NeuroScience Center, University of Washington, Seattle WA, USA; Department of Neurological Surgery, University of Washington, Seattle WA, USA; Department of Neurology, University of Washington, Seattle WA, USA.
⁴ Stroke & Applied NeuroScience Center, University of Washington, Seattle WA, USA.
⁵ Stroke & Applied NeuroScience Center, University of Washington, Seattle WA, USA; Elson S. Floyd College of Medicine, Washington State University, Spokane WA, USA.
⁶ Stroke & Applied NeuroScience Center, University of Washington, Seattle WA, USA; Department of Neurological Surgery, University of Washington, Seattle WA, USA; Department of Radiology, University of Washington, Seattle WA, USA; Mechanical Engineering, University of Washington, Seattle WA, USA. Electronic address: [email protected].

PMID: 39401576
DOI: 10.1016/j.jstrokecerebrovasdis.2024.108072

Abstract

Background: Post-stroke seizure (PSS) increases morbidity and mortality after ischemic stroke, but a comprehensive understanding of its incidence and risk factors is lacking. We report the rate and risk factors of PSS at a single institution.

Methods: A retrospective cohort study of adult acute ischemic stroke patients between 2018 and 2022 at a comprehensive stroke center was conducted. Patients with a history of seizures, additional stroke during index admission, or death within 7 days of stroke onset were excluded. Early PSS was defined as a new seizure occurring ≤7 days after stroke onset, while late PSS occurred >7 days after stroke onset. Multivariable logistic regression and cox proportional hazard analysis was conducted.

Results: 1211 participants met inclusion criteria. Patients were a mean age of 67.82 and were primarily male (58.7 %), white (72.6 %), and non-Hispanic (91.9 %). Incidence of PSS was 8.8 % (n = 106), of which 53.8 % (n = 57) were early and 46.2 % (n = 49) were late. Bivariate analysis identified younger age, diabetes, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early Computed Tomography Score ≤5, cortical involvement, and hemorrhagic transformation as significant in the development of PSS. Multivariable cox proportional hazard analysis identified cortical involvement (hazard ratio [HR]: 2.31, 95 % confidence interval [CI] [1,29, 4.14]), NIHSS ≥ 21 (HR: 1.82, 95 % CI [1.02, 3.22]),and younger age (HR: 0.97, 95 % CI [0.96, 0.98]) as significant PSS predictors.

Conclusion: PSS occurred in 8.8 % of patients presenting with ischemic stroke. Hemorrhagic transformation, cortical involvement, high NIHSS, and younger age were significant predictors of PSS.

Keywords: Hemorrhage; Ischemic stroke; Risk factors; Seizure.

MeSH terms

Age Factors
Aged
Aged, 80 and over
Disability Evaluation
Female
Humans
Incidence
Ischemic Stroke* / diagnosis
Ischemic Stroke* / epidemiology
Ischemic Stroke* / mortality
Male
Middle Aged
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Seizures* / diagnosis
Seizures* / epidemiology
Seizures* / etiology
Time Factors