Prevalence and predictors of early seizure and status epilepticus after first stroke

Background: Early seizure (ES) has been reported in 2% to 6% of strokes and is a predictor of recurrent seizures. Acute stroke has been reported to cause 22% of all cases of status epilepticus in adults. The determinants of ES and status epilepticus (SE) after stroke, however, are not well understood. Methods: An incidence study was conducted to identify all cases of first stroke in adult residents of northern Manhattan. Cases of ES and SE within 7 days of stroke were identified through medical record review. Statistical analyses were performed using univariate and multivariate logistic regression models. Results: The cohort consisted of 904 patients; ES occurred in 37 (4.1%). The frequency of ES by stroke subtype and location was deep infarct 0.6% (2/356), lobar infarct 5.9% (20/341), deep intracerebral hemorrhage (ICH) 4.0% (4/101), lobar ICH 14.3% (7/49), and subarachnoid hemorrhage 8.0% (4/50). SE occurred in 10 patients (1.1%), representing 27.0% of patients with ES. Diabetes, hypertension, current smoking, alcohol use, age, gender, and race/ethnicity were not significant determinants of ES. In a subgroup of patients who had an NIH stroke scale (NIHSS) score recorded, NIHSS score was not an independent predictor of ES in multivariate analysis. After accounting for stroke severity, ES was not a predictor of 30-day case fatality. Conclusions: Lesion location and stroke subtype are strong determinants of ES risk, even after adjusting for stroke severity. ES does not predict 30-day mortality. SE occurs in more than one-quarter of patients with ES.