Post‑stroke seizure and epilepsy after intravenous alteplase: A retrospective cohort with SeLECT score profiling

The purpose of this study was to evaluate the incidence of post-stroke seizures (PSS) and post-stroke epilepsy (PSE) in patients with ischemic stroke who received thrombolytic therapy.

This was a retrospective, single‑center cohort of consecutive alteplase‑treated patients with age‑ and sex‑matched non‑thrombolysed controls between 2016 and 2023. PSS incidence was ascertained from patients' records and PSE occurrence was registered based on structured telephone interviews. Multivariable logistic regression was used to evaluate the association between alteplase exposure and PSE, adjusting for baseline seizure risk.

A total of 398 patients were enrolled in the study of whom 10 developed PSE. The mean NIHSS score for PSE patients was 10.2 ± 5.3 and the mean SeLECT score was 4.7 ± 1.7. The unadjusted incidence of PSE differed between the alteplase and control groups. In multivariable logistic regression analysis adjusting for baseline seizure risk using the SeLECT score, alteplase exposure was associated with higher odds of PSE; however, this association did not reach statistical significance (OR 4.09, 95 % CI 0.85-19.76; p = 0.080).

In this retrospective cohort, alteplase exposure was not significantly associated with PSE after adjustment for baseline seizure risk. Although the point estimate suggested a possible increase in PSE risk, the small number of outcome events limits definitive conclusions. Larger prospective studies are needed to better clarify the relationship between thrombolysis and PSE.