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Post-stroke seizures are clinically underestimated

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Abstract

Cerebrovascular disease is the leading cause of epilepsy in adults, although post-stroke seizures reported frequency is variable and few studies used EEG in their identification. To describe and compare EEG and clinical epileptic manifestations frequency in patients with an anterior circulation ischaemic stroke. Prospective study of acute anterior circulation ischaemic stroke patients, consecutively admitted to a Stroke Unit over 24 months and followed-up for 1 year. All patients underwent standardized clinical and diagnostic assessment. Seizure occurrence was clinically evaluated during hospitalization and by a telephone interview at 6 months and a clinical appointment at 12 months after stroke. Video-EEG was performed in the first 72 h (1st EEG), daily after the 1st EEG for the first 7 days after the stroke, or later if neurological worsening, at discharge, and at 12 months. 151 patients were included (112 men) with a mean age of 67.4 (11.9) years. In the 1st year after stroke, 38 patients (25.2%) had an epileptic seizure. During hospitalization, 27 patients (17.9%) had epileptiform activity (interictal or ictal) in the EEG, 7 (25.9%) of them electrographic seizures. During the first week after stroke, 22 (14.6%) patients had a seizure and 4 (2.6%) non-convulsive status epilepticus criteria. Five (22.7%) acute symptomatic seizures were exclusively electrographic. At least one remote symptomatic seizure occurred in 23 (16%) patients. In the first 7 days after stroke, more than one-fifth of patients with seizures had exclusively electrographic seizures. Without a systematic neurophysiological evaluation the frequency of post-stroke seizures are clinically underestimated.

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Acknowledgements

We are obliged to EEG technicians Joana Pires, Lígia Ferreira e Rosa Santos. We are also grateful to all nurses and medical residents working in the Stroke Unit between 2011 and 2013 for their support to this Project.

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Authors and Affiliations

  1. EEG/Sleep Laboratory/Stroke Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, CHLN, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal

    Carla Bentes, Ana Rita Peralta, Ana Catarina Franco, Ana Catarina Fonseca, Ruth Geraldes, Patrícia Canhão, Teresa Pinho e Melo & José M. Ferro

  2. Faculty of Medicine, University of Lisbon, Lisbon, Portugal

    Carla Bentes, Ana Rita Peralta, Carlos Morgado, Ana Catarina Fonseca, Ruth Geraldes, Patrícia Canhão, Teresa Pinho e Melo & José M. Ferro

  3. Department of Medicine 1.2., Hospital de São José, CHLC, Lisbon, Portugal

    Hugo Martins

  4. Department of Neuroradiology, Hospital de Santa Maria, CHLN, Lisbon, Portugal

    Carlos Casimiro & Carlos Morgado

  5. Eletroencefalography and Clinic Neurophysiology Centre (CENC), Lisbon, Portugal

    Teresa Paiva

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  1. Carla Bentes
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  2. Hugo Martins
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  12. José M. Ferro
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Corresponding author

Correspondence to Carla Bentes.

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Funding

The 2012 Research Grant in Cerebrovascular Diseases (scientific promoter: Stroke Portuguese Society (SPAVC)/Sponsor: Tecnifar), supported this work.

Conflicts of interest

Dr. Bentes received the 2012 Research Grant in Cerebrovascular Diseases (Scientific Promoter: Sociedade Portuguesa do AVC/Sponsor: Tecnifar). Dr. Ferro reports personal fees from Boehringer Ingelheim, outside the submitted work. Other authors have nothing to disclose.

Ethics approval

This study has been approved by the Ethics Committee “Comissão de Ética para a Saúde” of the HSM-CHLN and has, therefore, been preformed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Bentes, C., Martins, H., Peralta, A.R. et al. Post-stroke seizures are clinically underestimated. J Neurol 264, 1978–1985 (2017). https://doi.org/10.1007/s00415-017-8586-9

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  • DOI: https://doi.org/10.1007/s00415-017-8586-9

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