Risk factors of epilepsy recurrence in patients with post-stroke epilepsy

To explore the risk factors for epilepsy recurrence in patients with post-stroke epilepsy (PSE), and to determine the optimal timing of anti-epileptic drug administration.

This retrospective study collected clinical data from 90 patients with post-stroke epilepsy (PSE) admitted to Baoding Third Central Hospital from February 2021 to December 2023. Patients were grouped based on epilepsy recurrence. Baseline data, including lesion characteristics, blood homocysteine levels, the National Institute of Health Stroke Scale (NIHSS) scores, and anti-epileptic drug therapy treatment effects, were compared between the recurrent and non-recurrent groups. Logistic analysis was done to determine the risk factors for epilepsy recurrence in patients with PSE.

Logistic analysis confirmed that stroke lesion located in the cortex, lesion size ≥ 3 cm, post-stroke late seizure, intracerebral hemorrhage (ICH), blood leakage into the surrounding infarcted tissue, hyperhomocysteinemia (HHcy), and NIHSS scores of ≥ 15 are risk factors for epilepsy recurrence in patients with PSE (P < 0.05). In the recurrent group, a statistically significant difference in treatment effect was found among patients who received anti-epileptic drugs at different time points (P < 0.05). The total efficacy was higher in the early-onset treated (90.91%), early-onset untreated (85.71%), and late-onset treated (80.00%) groups than in the late-onset untreated group (40.00%). In addition, the total effectiveness differed significantly between the early-onset treated and late-onset untreated groups (P < 0.05).

Lesion location and size, timing of epileptic seizures, ICH, hemorrhagic transformation, HHcy, and NIHSS scores were identified as risk factors for epilepsy recurrence in patients with PSE. Although early-onset PSE does not require early anti-epileptic treatment, timely treatment should be administered in late-onset cases.