Timing of Post-Stroke Seizures and Functional Outcomes: Exploring Gender-Based Disparities

Post-stroke complications significantly influence functional recovery, with seizures representing a critical determinant of poor outcomes. While acute symptomatic seizures (ASS) may reflect initial injury severity, remote symptomatic seizures (RSS) potentially exacerbate neurological damage. Emerging evidence suggests gender may modulate these relationships, though comprehensive studies remain limited.

This study aimed to: (1) evaluate the impact of seizure timing (acute vs. remote), and (2) investigate gender-specific disparities in recovery patterns.

We conducted a retrospective case-control study (2018-2021) of 232 patients (116 post-stroke seizure [PSS], 116 controls) matched by age, gender, and stroke type. Stroke severity was assessed using National Institutes of Health Stroke Scale/Score (NIHSS) Calculator, with functional outcomes measured via modified Rankin Scale (mRS) at discharge and 3 months. Statistical analyses included Fisher's exact tests for categorical variables and Mann-Whitney tests for continuous measures, with multivariable regression adjusting for confounders.

PSS patients demonstrated worse functional outcomes, particularly in hemorrhagic strokes (78.3% vs. 21.7% poor outcomes, P<0.001) and right-sided lesions (OR 2.7, P=0.017). Females with RSS had markedly poorer recovery than ASS cases (OR 0.1, 95% CI 0.1-0.9, P=0.015), while males showed no timing-dependent differences. Vascular comorbidities (e.g., chronic kidney disease [OR 37.5], Diabetes mellitus [OR 2.3], and smoking [OR 1.4]) compounded poor outcomes.

RSS, especially in females, and hemorrhagic stroke are high-risk predictors of disability. Targeted seizure prophylaxis and gender-sensitive rehabilitation strategies may improve outcomes. Prospective studies should validate these associations and explore underlying mechanisms.