Clinical profile and outcome of early and delayed seizures after acute ischemic stroke

Abstract

Objectives: To assess the incidence and predictive factors and outcome of seizures after ischemic stroke. Materials and Methods: Clinical data of 67 patients with post-stroke seizures treated between January 2009 to June 2013 was evaluated. Results: There were 1194 patients with ischemic stroke during the study period among whom 855 (71.6%) were in anterior circulation, 316 (26.5%) in posterior circulation and 23 in both anterior and posterior circulations. Sixty-seven of these patients (males 49, females 18) had post-stroke seizures (5.6%). Fifty patients had anterior circulation stroke (middle cerebral 46, anterior cerebral 3, internal carotid 1), 14 (25%) patients had posterior circulation stroke and three had border zone infarct. Twelve patients (17.9%) had cardiogenic embolism. Three patients (4.5%) had hemorrhagic transformation. Thirty-four patients had partial seizures with or without generalization whereas 33 patients had generalized tonic clonic seizures without partial onset. Among the whole group with ischemic stroke, early onset seizures were seen in 22 (1.8%) patients and ten patients (0.8%) developed status epilepticus. Majority (83.6%) had cortical with or without sub-cortical infarcts, 16.4% had sub-cortical infarction. Seizures were controlled with single antiepileptic medication in 40 patients; two drugs in 21 and five required multiple drugs. One patient died of status epilepticus. Conclusion: Occurrence of post-stroke seizures in patients with ischemic stroke was 5.6%. Seizures occurred more commonly in anterior circulation cortical ischemic strokes. Seizures occurred more frequently in late phase of post-stroke period compared to early onset and majority could be controlled with single drug.

Keywords

• Acute ischemic stroke
• hemorrhagic infarction
• post-stroke seizures