Identifying clinical and imaging predictors of post stroke epilepsy.

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.