Abstracts

Rationale: Although there have been national reports of the incidence and risk factors of seizures after ischemic stroke, specific data in historically less diverse US regions such as Central Pennsylvania are lacking. This study aims to provide foundational data that could inform the development of a national post-stroke epilepsy registry

Methods: We identified patients with ischemic stroke hospitalized in the largest and only academic institution of Central Pennsylvania with a comprehensive stroke center and level IV epilepsy center between January 2020 and December 2021. Only patients with imaging evidence of supra-tentorial (middle cerebral artery, anterior cerebral artery, or posterior cerebral artery) ischemic strokes and available follow up at 1-year post-stroke were included in the current analysis. Incident late seizures were identified as reported by a physician (either as recorded in the medical record or any “yes” to the question “have you ever been told by your doctor that you have seizures or epilepsy since your stroke?”). We compared patients with late seizure and those without late seizures. We performed a multivariable logistic regression analysis (model 1: adjusted for age, sex, race/ethnicity, model 2: model 1 + discharge NIHSS, hemorrhagic transformation, and model 3: model 2 + seizures at 7 days and Large artery atherosclerosis).


Results: A total of 103 patients had ischemic stroke and information about late seizure occurrence after 7days and up to 1-year post stroke. Late seizures developed in 17 patients (16.5%). The mean age of patients was 69 years for those with late seizures and 68 years for those without late seizures. Forty-two percent of participants were female, 83% were Non-Hispanic Whites, 11% were Non-Hispanic Black, 3% were Asians, and 3% were Hispanics. No statistically significant differences in the incidence of late seizures were found based on sex, age, or race/ethnicity. Early seizures (18.2% vs. 1.2%, P = 0.033), parenchymal hemorrhage-PH2 (17.7% vs. 3.5%, P = 0.049), and large artery atherosclerotic disease (28.2% vs. 12.0%, P = 0.034) were significantly associated with late seizures. In the multivariable logistic regression model, race was independently associated with late seizures (adjusted OR: 4.72, 95%CI: 1.06-21.05) (model 1), discharge National Institute of Health Stroke Scale (NIHSS) but not admission NIHSS was an independent predictor of late seizure (adjusted OR: 31.1, 95%CI: 2.2-445.1) (model 2).


Conclusions: In this prospective analysis of patients with ischemic stroke in Central Pennsylvania, late seizures occurred in 16.5% of patients cumulatively at 1-year post-stroke. Non-Hispanic Black patients and higher discharge NIHSS scores were associated with an increased risk of developing late seizures post-ischemic stroke. This study supports the feasibility and need for a nationwide post-ischemic stroke registry to better understand stroke-related complications.


Funding: Sergievsky Award for Epilepsy Health Equity and Diversity.