Abstracts

What Is an Acute Symptomatic Seizure: The Impact of Seizure Timing on Seizure Recurrence After Stroke

Abstract number : 2.275
Submission category : 4. Clinical Epilepsy / 4D. Prognosis
Year : 2024
Submission ID : 779
Source : www.aesnet.org
Presentation date : 12/8/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Kai Michael Schubert, MD PhD – Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland

Giulio Bicciato, MD – Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
Vineet Punia, MD – Cleveland Clinic
Vijaya Dasari, MD – Epilepsy Center, Cleveland Clinic, Cleveland, OH, United States.
Matias Alet, MD – Centro Integral de Neurología Vascular, Fleni. Ciudad Autónoma de Buenos Aires, Argentina.
Laura Abraira, MD PhD – Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona; Universitat Autonoma de Barcelona, Bellaterra, Spain
Estevo Santamarina, MD, PhD – Vall d'Hebron University Hospital
José Álvarez-Sabín, PhD – Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona; Universitat Autonoma de Barcelona, Bellaterra, Spain
Carolina Ferreira-Atuesta, MD, MSc – Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
Mira Katan, MD MSc – Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
Nico Döhler, MD – Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
Barbara Erdélyi-Canavese, MD – Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
Dominik Zieglgänsberger, MD – Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
Ansgar Felbecker, MD – Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
Philip Siebel, MD – Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
Michael Winklehner, MD – Johannes Kepler University Linz, Kepler University Hospital, Department of Neurology, Altenberger Straße 69, 4040 Linz and Wagner-Jauregg Weg 15, 4020 Linz, Austria
Tim J von Oertzen, MD FRCP – Johannes Kepler University Linz, Kepler University Hospital, Department of Neurology, Altenberger Strasse. 69, 4040 Linz and Wagner-Jauregg Weg 15, 4020 Linz, Austria
Judith N. Wagner, MD – Department of Neurology, Evangelisches Klinikum Gelsenkirchen, Academic Hospital University Essen-Duisburg, Gelsenkirchen, Germany
Gian Luigi Gigli, MD – Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
Annacarmen Nilo, MD – Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
Francesco Janes, MD PhD – Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
Giovanni Merlino, MD PhD – Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
Mariarosaria Valente, MD – Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
María Paula Zafra-Sierra, MD – Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
Luis Carlos Mayor-Romero, MD – Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
Julian Conrad, MD – Division for neurodegenerative diseases, Department of Neurology, Universitaetsmedizin Mannheim, University of Heidelberg
Stefan Evers, MD – Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
Piergiorgio Lochner, MD – Department of Neurology, Saarland University Medical Center, Homburg, Germany
Frauke Roell, MD – Department of Neurology, Saarland University Medical Center, Homburg, Germany
Francesco Brigo, MD – Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
Ana Lúcia Oliveira, MD – Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHULN. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
Carla Bentes, MD PhD – Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHULN. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
Ana Rita Peralta, MD – Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHULN. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
Teresa Pinho E Melo, MD – Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHULN. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
Mark R Keezer, MDCM PhD – Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
John Duncan, MD – University College London
Josemir W Sander, FRCP FMedSci – Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
Barbara Tettenborn, MD – Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
Matthias J Koepp, MD PhD – Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
Marian Galovic, MD PhD – Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland

Rationale: The current practice of categorizing first seizures after stroke as acute (within seven days post-stroke) or remote (day eight or later) symptomatic centers on the assumption of a high ( >60%) risk of seizure recurrence. Despite the significant diagnostic and therapeutic implications, robust evidence validating this 7-day threshold for distinguishing acute from remote symptomatic seizures following a stroke is lacking.

Methods: From 11 international cohorts, we included participants with neuroimaging-confirmed acute ischemic stroke (mean age 73 years, 56% male) and either an acute or remote symptomatic first seizure. We employed Cox proportional hazards regression adjusted for treatment effects using inverse probability weighting to assess the impact of first seizure timing on the risk of recurrence (Figure 1, Panel A).

Results: Of the 519 stroke survivors who experienced a first seizure, 177 (34%) had recurrent seizures during follow-up. Seizures occurring within the first month after stroke had a cumulative recurrence risk of less than 60% over ten years (day 0: 49%; week 1: 44%; week 2: 25%; weeks 3-4: 40%; Figure 1, Panel C). First seizures occurring more than one month after stroke had a greater than 60% risk of recurrence, meeting the current practical definition of epilepsy (months 1-3: 88%; months 4-6: 98%; months 7-9: 92%; months 10-12: 70%; months 13-18: 85%; Figure 1, Panel C). The risk of recurrence dropped slightly following the first seizures occurring more than 1.5 years after the stroke (months 19-24: 60%; 2-3 years: 46%; 3 years or later: 40%; Figure 1, Panel C).


Conclusions: The risk of recurrence following a seizure during the first post-stroke month is moderately low (< 60%), challenging the conventional 7-day cutoff for defining acute symptomatic seizures. These findings may shape decisions on whether and when to start antiseizure medications following post-stroke seizures.
Clinical Epilepsy