Abstracts

Rationale: In most populations, cerebrovascular disease represents the main cause of provoked seizures in adults. The presence of acute symptomatic seizures influences short-term outcome after stroke; however, scarce information exists on the association of seizures with long-term outcome. We aimed to describe the factors associated with symptomatic seizures after acute ischemic stroke and the impact on functional outcome at 12-month follow-up. Methods: This is a descriptive cohort study on 1246 non-epileptic patients with acute ischemic stroke included in a multicenter Mexican registry, who received long-term follow up after a first-ever or recurrent brain infarction. Multivariate analyses were performed to evaluate factors associated with acute provoked seizures and the functional outcome at 12-month follow-up. Results: The frequency of provoked seizures after acute ischemic stroke was 8.1% [95% confidence interval (CI): 6.7% to 9.8%]. In a binary logistic regression model, risk factors significantly associated with provoked seizures were a scoring of the National Institutes of Health Stroke Scale (NIHSSS, US) >10 [odds ratio (OR): 2.21, 95% CI: 1.40-3.47], recurrent ischemic stroke (OR: 2.17, 95% CI: 1.34-3.53) and age <65 years (OR: 1.69, 95% CI: 1.09-2.62). After a Cox proportional hazards model and Kaplan-Meier actuarial analyses, the presence of provoked seizures was significantly associated with the risk of important functional disability or death (a modified Rankin scale >3) at 12-month follow-up [hazard ratio (HR): 1.37, 95% CI: 1.04-1.83], as well as NIHSS >10 (HR: 4.47, 95% CI: 3.53-5.65), age ≥65 years (HR: 1.74, 95% CI: 1.38-2.20), heart failure (HR: 1.61, 95% CI: 1.22-2.13) and atrial fibrillation (HR: 1.35, 95% CI: 1.05-1.74). Conclusions: The frequency of provoked seizures after acute ischemic stroke in this cohort was 8%. Age <65 years and severity of the brain infarction are the main risk factors for acute provoked seizures. In turn, provoked seizures represent a factor associated with functional disabilities or death one year after acute ischemic stroke.