Poststroke Seizures Associated With Increased Risk for Functional Disability, Death

Erwin Chiquete, MD, PhD

Results from a study evaluating the frequency and impact of poststroke seizures on 1-year outcomes suggest that patients who experience acute seizures have an increased risk of developing physical and/or mental disabilities, as well as an increased risk of death.. The findings were presented at the American Stroke Association’s 2020 International Stroke Conference (ISC), February 19-21, 2020, in Los Angeles, California.^1,2

“In the United States, stroke is the most common cause of epilepsy in adults. In Mexico, stroke is now the leading cause of epilepsy in adults as well. However, we suspect that seizures and epilepsy in stroke patients are still under-recognized by physicians,” Erwin Chiquete, MD, PhD, lead study author and a neurologist and researcher at the Salvador Zubiran National Institute of Medical Sciences and Nutrition in Mexico City, Mexico, said in a statement.²

The study evaluated 1246 nonepileptic patients between the ages of 18 and 94 (85% >40) who experienced a first or recurrent acute ischemic stroke (AIS) and were followed-up with for 12 months. Investigators aimed to identify risk factors that could potentially predict seizures or epilepsy poststroke, as well as the direct impact these seizures may have on disability and death.

The frequency of acute seizures (within 7 days after stroke onset) in patients with AIS was 8.1% (95% CI, 6.7%-9.8%), and the seizure recurrence rate was 4.8% at 12-month follow-up (95% CI, 3.7%-6.1%).

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Investigators noted several risk factors significantly associated with seizures using a binary logistic regression model. Among them were scores of >10 on the National Institutes of Health Stroke Scale (NIHSSS; odds ratio [OR] 2.21; 95% CI, 1.40 — 3.47), recurrent ischemic stroke (OR 2.17; 95% CI, 1.34 – 3.53) and age <65 years (OR 1.69; 95% CI, 1.09 – 2.62).

Development of acute seizures poststroke was associated with a 37% greater chance of functional disability or death (HR 1.37; 95% CI, 1.04—1.83). In addition, other factors associated with increased risk for death or disability were NIHSS >10 (HR 4.47; 95% CI, 3.53-5.65), age ≥65 years (HR 1.74; 95% CI, 1.38-2.20), heart failure (HR 1.61; 95% CI, 1.22-2.13) and atrial fibrillation (HR 1.35; 95% CI, 1.05-1.74).

Notably, patients between the ages of 18 to 40 were among the most vulnerable, with 13% of those patients developing recurrent seizures and receiving a subsequent epilepsy diagnosis. Overall, developing seizures was 69% more likely in patients younger than 65.

“We think that the secondary prevention of ischemic stroke and controlling seizures with antiepileptic medication during the 12 months after stroke are very important to prevent death and to decrease disability,” Chiquete said in a statement. “Our research suggests that severe ischemic stroke can cause epilepsy in a higher percentage of patients than we originally thought or has been shown in previous studies.”

For more coverage of ISC 2020, click here.

REFERENCES:

1. Ramirez-Garcia G, Sandoval-Rodriguez V, Flores-Silva F, Ruiz-Sandoval JL, Cantu-Brito C. 12-month epilepsy outcomes in patients with acute ischemic stroke. Presented at: 2020 International Stroke Conference. February 19-21, 2020; Los Angeles, CA. Abstract 162.

2. Developing seizures after stroke may increase risk of death, disability [news release]. Dallas, TX: American Stroke Association. February 12, 2020. newsroom.heart.org/news/developing-seizures-after-stroke-may-increase-risk-of-death-disability. Accessed February 20, 2020.