Atrial fibrillation as an independent predictor of early epileptic seizures after acute ischemic stroke.

BACKGROUND

Early epileptic seizures (EES) are a known complication of acute ischemic stroke (AIS) and are associated with unfavorable outcomes. Identifying independent predictors of EES may improve early risk stratification and monitoring strategies.

METHODS

We retrospectively analyzed 1124 consecutive AIS patients; 47 (4.2%) developed EES. Demographic, clinical, and radiological variables were compared between patients with and without EES. Independent predictors were identified using multivariable logistic regression analysis.

RESULTS

Patients with EES were older and more frequently had cortical involvement, particularly frontal and temporal lobe lesions. Higher stroke severity (NIHSS > 10), hemorrhagic transformation, atrial fibrillation, and hypertension were significantly more common in the EES group. Mortality was higher among patients with EES. In multivariable analysis, independent predictors of EES included increasing age (OR 1.12 per year), cortical involvement (OR 9.50), frontal (OR 2.53) and temporal lobe involvement (OR 2.92), hemorrhagic transformation (OR 4.90), atrial fibrillation (OR 3.21), and hypertension (OR 2.57) (all p < 0.05). Higher stroke severity (NIHSS > 10) was more frequent in the EES group in univariable analysis but showed an inverse association after multivariable adjustment.

CONCLUSIONS

EES after AIS are independently associated with cortical involvement, hemorrhagic transformation, atrial fibrillation, hypertension, and advanced age. Recognition of these factors may support early EEG monitoring and individualized management of patients at increased seizure risk.