Outcome and predictive factors in post-stroke seizures: A retrospective case-control study

Area of Science:

• Neurology
• Neurosurgery
• Stroke Medicine

Background:

• Ischemic stroke can lead to post-stroke seizures (PSS), impacting patient prognosis.
• Understanding the factors contributing to PSS is crucial for effective management.
• Clinical, radiographic, and electrophysiological features require thorough evaluation.

Purpose of the Study:

• To identify clinical, radiographic, and electrophysiological predictors of PSS development.
• To assess the prognostic implications of PSS after ischemic stroke.
• To analyze stroke characteristics associated with PSS.

Main Methods:

• Retrospective analysis of 1119 patient records from January 2006 to December 2016.
• Matched cohort study comparing 42 PSS patients with 60 controls without seizures.
• Analysis of stroke size (ASPECTS), severity (NIHSS), hemorrhagic transformation (ECASS III), and outcomes (mRS).

Main Results:

• Stroke localization and severity did not differ between groups.
• Larger anterior circulation stroke size (ASPECTS 6 vs 8, p=0.01) was associated with PSS.
• Hemorrhage presence (61.9% vs 36.7%, p=0.01), laminar necrosis (LN) (47.6% vs 21.6%, p=0.005), and hemosiderin deposition (38.1% vs 18.3%, p=0.02) were significant predictors.
• PSS patients had worse outcomes (median mRS 3 vs 2, p<0.001).

Conclusions:

• Anterior infarct size and the presence of blood products (hemorrhage, LN) within the infarct bed are key predictors of PSS.
• Laminar necrosis is particularly predictive of post-stroke seizures.
• PSS is associated with poorer neurological outcomes.