Identifying clinical and imaging predictors of post stroke epilepsy

Abstract

Introduction: Stroke is one of the leading causes of symptomatic epilepsy in adults. We report on mortality and predictors of post-stroke epilepsy in a tertiary care center and compare with prognostic scores (e.g. SeLECT and CAVE) to predict the risk of late seizures after stroke.

Methods: This retrospective study included patients with stroke (January 2016-June 2022). Demographic factors, haemorrhagic transformation, cortical involvement, location, vascular territory, number of lobes involved, early seizures, stroke severity, presence of large-artery atherosclerosis and bleeding > 10 ml were analyzed; the relationship between post-stroke epilepsy and prognostic instruments which predict the risk of late seizures after stroke were analyzed.

Results: We included 760 patients with stroke (91.18% ischemic and 8.82% haemorrhagic). Post-stroke epilepsy was observed in 8.08% and 13.43% of ischemic and haemorrhagic events respectively with a median age of 70.68 (20-95). Predictors of post-stroke epilepsy included: temporal lobe involvement, NIHSS ≥ 11, middle cerebral artery territory, bleeding > 10 ml, early seizures, cortical involvement, SeLECT ≥ 4 and CAVE ≥ 3. In ischemic stroke, the cumulative risk of a first late seizure was 10 % (20 months), 20 % (40 months) and 25 % (60 months). In hemorrhagic stroke, the risk was 37 % (10 months) and 50 % (20 months). CAVE demonstrated a strong correlation with seizure risk (score > 2 leading to a 60 % cumulative risk).

Conclusion: The prevalence of post-stroke epilepsy was 8.55 %. We found a statistically significant association with: temporal lobe involvement, NIHSS ≥ 11 points, MCA territory, cortical involvement, early seizures, presence of large-artery atherosclerosis, bleeding > 10 ml, SeLECT score ≥ 4 points, CAVE score ≥ 3 points.

Keywords: Epilepsy; Post-stroke epilepsy; Stroke.