Post-stroke epilepsy in revascularized versus not revascularized stroke patients: A prospective cohort study

The association between post stroke epilepsy (PSE) and revascularization therapy in stroke patients remains controversial. The prognostic significance of other supportive techniques such as Computed Tomography (CT) brain data and electroencephalograph (EEG) in PSE prediction is poorly understood.

We performed a single-center prospective observational study to evaluate the incidence of acute symptomatic seizures (ASS) and PSE in adult patients affected by acute ischaemic stroke undergoing reperfusional approaches compared to non-revascularized patients, with a 30-months follow-up.

We enrolled 258 patients with stroke: 155 cases (treated with intravenous tissue plasminogen activator (IV-tPA)) and/or endovascular thrombectomy (ET) and 103 controls (non-revascularized). The global incidence of ASS was 3.4%, while PSE was diagnosed in 5% of patients. Reperfusion treatments were not associated with increased risk of ASS or PSE. Hemorrhagic infarction was found as the only independent risk factor for PSE development (HR 5.33, (95% CI, 1.69 - 16.82), p=0.004). In parallel, we analyzed the relationship between ASS and hemorrhagic infarction using the chi-square test (OR 8.59 (95% CI, 2.19 - 33.7), p < 0.001).

Reperfusion therapies for acute ischemic stroke do not increase the risk of epilepsy during the first 30 months after stroke. Hemorrhagic infarction was the main risk for epilepsy after stroke.