[ARTICLE] Seizures Do Not Affect Disability and Mortality Outcomes of Stroke: A Population-Based Study – Full Text

Abstract

Although seizures are frequently seen after cerebrovascular accidents, their effects on long-term outcome in stroke patients are still unknown. Therefore, the aim of this study was to investigate the relationship between post-stroke seizures and the risk of long-term disability and mortality in stroke patients. This study is part of a larger population-based study. All patients were prospectively followed up by a face-to-face interview or a structured telephone interview. We enrolled 635 patients with first-ever stroke and without a history of seizures. Prevalence of ischemic stroke (IS) was 85.2%, while the remaining 14.8% of patients were affected by intracerebral hemorrhage (ICH). During the study period, 51 subjects (8%) developed post-stroke seizures. Patients with post-stroke seizures were younger, had a higher prevalence of ICH, had a more severe stroke at admission, were more likely to have an IS involving the total anterior circulation, and were more likely to have a lobar ICH than patients without seizures. Moreover, subjects with seizures had more frequently hemorrhagic transformation after IS and cortical strokes. At 24 months, the risk of disability in patients with seizures was almost twice than in those without seizures. However, the negative effect of seizures disappeared in multivariate analysis. Kaplan-Meier survival curves at 12 years were not significantly different between patients with and without post-stroke seizures. Using the Cox multivariate analysis, age, NIHSS at admission, and pre-stroke mRS were independently associated with all-cause long-term mortality. In our sample, seizures did not impair long-term outcome in patients affected by cerebrovascular accidents. The not significant, slight difference in favor of a better survival for patients with seizures may be attributed to the slight age difference between the two groups.

1. Introduction

Seizures are frequently seen after cerebrovascular accidents. Acute symptomatic or early seizures (ES) affect between 3% and 6% of all stroke patients [1,2,3,4,5,6], whereas unprovoked or late seizures (LS) have been reported in 10 to 12% of stroke patients [7,8].
Although determinants and correlates of ES and LS after stroke have been largely investigated [1,6,9,10,11,12,13,14,15,16,17], the effect of seizures on long-term outcome in stroke patients is still unknown. In fact, previous studies focused their interest on short-term mortality [2,12,18,19,20,21,22], and only a few of them reported results on disability that was assessed only at discharge [13,18,19,21,22].
Recently, Claessens et al. conducted a retrospective study to explore a possible association between post-stroke seizures and long-term mortality. After correction for possible confounding variables, the authors concluded that seizures were not significantly related to mortality risk [23]. Conversely, in the prospective Future study, Arntz et al. showed that post-stroke seizures negatively affect long-term disability and mortality [24,25]. Differences in the population study might explain these conflicting findings. In particular, Claessens et al. included only patients with intracerebral hemorrhage (ICH), whereas Arntz et al. included only young patients, aged 18 to 50 years, after transient ischemic attack (TIA), ischemic stroke (IS) or ICH [23,24,25]. Bearing in mind that ICH accounts for almost 15% of all strokes and that cerebrovascular accidents are largely more common in subjects older than 50 years, these results cannot be directly generalizable to all stroke patients.
Therefore, the aim of this study was to investigate the relationship between post-stroke seizures and the risk of long-term disability and mortality in patients affected by cerebrovascular accidents.[…]

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