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. 2020 Mar 2;10(1):3779.
doi: 10.1038/s41598-020-60628-9.

National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases

Johann Philipp Zöllner  1   2 , Björn Misselwitz  3 , Manfred Kaps  4 , Marco Stein  5 , Jürgen Konczalla  6 , Christian Roth  7   8 , Karsten Krakow  9 , Helmuth Steinmetz  10 , Felix Rosenow  10   11 , Adam Strzelczyk  10   11   8
Affiliations

National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases

Johann Philipp Zöllner et al. Sci Rep. .

Abstract

The National Institutes of Health Stroke Scale (NIHSS) score is the most frequently used score worldwide for assessing the clinical severity of a stroke. Prior research suggested an association between acute symptomatic seizures after stroke and poorer outcome. We determined the frequency of acute seizures after ischemic stroke in a large population-based registry in a central European region between 2004 and 2016 and identified risk factors for acute seizures in univariate and multivariate analyses. Additionally, we determined the influence of seizures on morbidity and mortality in a matched case-control design. Our analysis of 135,117 cases demonstrated a seizure frequency of 1.3%. Seizure risk was 0.6% with an NIHSS score at admission <3 points and increased up to 7.0% with >31 score points. Seizure risk was significantly higher in the presence of acute non-neurological infections (odds ratio: 3.4; 95% confidence interval: 2.8-4.1). A lower premorbid functional level also significantly increased seizure risk (OR: 1.7; 95%CI: 1.4-2.0). Mortality in patients with acute symptomatic seizures was almost doubled when compared to controls matched for age, gender, and stroke severity. Acute symptomatic seizures increase morbidity and mortality in ischemic stroke. Their odds increase with a higher NIHSS score at admission.

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Conflict of interest statement

J.P.Z. reports a speaker’s honorarium from Eisai. F.R. reports personal fees from Eisai, GW Pharmaceuticals, and Desitin Arzneimittel; personal fees and others from Novartis; personal fees from Medtronic; personal fees from Cerbomed; personal fees from Shire; and grants from the European Union, the German Minister for Education and Research (BMBF), the LOEWE Programm of the state of Hessen, the Deutsche Forschungsgemeinschaft (DFG), and the Detlev-Wrobel-Fonds for Epilepsy Research. A.S. reports personal fees and/or grants from Arvelle Therapeutics, Desitin Arzneimittel, Eisai, GW Pharmaceuticals, LivaNova, Marinus Pharmaceuticals, Medtronic, Sage Therapeutics, UCB Pharma, and Zogenix. None of the other authors reports conflicts of interest.

Figures

Figure 1
Figure 1
The bottom number shows the count of patients with acute symptomatic seizures in this NIHSS range (x-axis), while the upper number shows the count of patients without seizures. NIHSS = National Institutes of Health Stroke Scale.
Figure 2
Figure 2
Risk factors are sorted by ascending ORs. Red diamonds indicate ORs; vertical black bars indicate 95% confidence intervals. mRS = modified Rankin Scale, NIHSS = National Institutes of Health Stroke Scale, OAC = oral anticoagulation.
Figure 3
Figure 3
The modified Rankin Scale (mRS) score at discharge demonstrates a shift toward worse outcomes for patients with acute symptomatic seizures as compared with those without.
See this image and copyright information in PMC

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