Early Post-stroke Seizures in Acute Ischaemic Stroke: A Retrospective Study

Introduction: Seizures represent an important complication of ischaemic stroke causing a substantial burden to post-stroke patients. Seizures occurring within one week after acute stroke onset are called early onset seizures. Several studies have tried to identify the risk factors for early seizures after stroke with controversial results.

Aim: To determine the risk factors of early post-stroke seizures in a retrospective cohort of acute ischaemic stroke.

Materials and Methods: This retrospective cohort study included medical records of 552 adult patients with acute ischaemic stroke between March 2017 to September 2022 admitted at Travancore Medical College Hospital, Kollam, Kerala, India. The patients were divided into two groups-stroke patients with early onset seizures and stroke patients without early onset seizures. The following parameters were compared between the two groups-age, gender, presenting symptoms, ischaemic subtype (TOAST {Trial of Org 10172 in Acute Stroke Treatment} classification), vascular territory involved, lesion location and lateralisation, infarct size, stroke severity based on National Institute of Health Stroke Scale (NIHSS), vascular risk factors, treatment (thrombolysis, antiplatelets, anticoagulants use) and related complications (haemorrhagic transformation, infection, gastrointestinal haemorrhage, hyponatraemia). Univariate analysis was done using Chi-square test and multivariate analysis using logistic regression test. Statistical Package for the Social Sciences (SPSS) version 27.0 statistical software was used, p-value<0.05 was considered statistically significant.

Results: Among 552 patients, 76 (13.8%) were stroke patients with early onset seizure group and 476 (86.2%) were stroke patients without early onset seizure group. A total of 84.2% of patients developed seizure within 24 hours of stroke onset. A total of 409 (74.1%) patients were males. Patients with early onset seizures were younger. The most common seizure type was unknown onset to bilateral tonic-clonic seizures (85.5%). Multivariate analysis identified severe NIHSS, supratentorial, cortical location, large artery disease, anticoagulation use, haemorrhagic transformation and hyponatraemia as independent factors for early onset seizures.

Conclusion: Severe NIHSS at presentation, large artery disease, supra tentorial, cortical location of infarct, use of anticoagulants, haemorrhagic transformation and hyponatraemia were significant risk factors of early seizures in acute ischaemic stroke. An early identification and understanding of these risk factors would help to prevent seizures in acute stroke patients.