EPILEPTIC SEIZURES AFTER A FIRST STROKE - THE OXFORDSHIRE COMMUNITY STROKE PROJECT

Objective: To describe the immediate and long term risk of epileptic s eizures after a first ever stroke. Design: Cohort study following up s troke survivors for 2 to 6.5 years; comparison with age specific incid ence rates of epileptic seizures in the general population. Setting: C ommunity based stroke register. Subjects: 675 patients with a first st roke, followed up for a minimum of 2 years. Main outcome measures: Occ urrence of single and recurrent seizures. Results: 52 patients had one or more post stroke seizures; in 25 the seizures were recurrent The 5 year actuarial risk of a post stroke seizure in survivors (excluding 19 patients with a history of epilepsy and 3 patients in whom the seiz ure occurred shortly before death from another cause) was 11.5% (95% c onfidence interval 4.8% to 18.2%). The relative risk of seizures, in c omparison with the general population, was estimated at 35.2 in the fi rst year after stroke and 19.0 in year 2. The risk of seizures was inc reased in survivors of subarachnoid and intracerebral haemorrhage (haz ard ratio for intracranial haemorrhage v cerebral infarction 10.2 (3.7 to 27.9)), The risk of seizures after ischaemic stroke was substantia l only in patients presenting with severe strokes due to total anterio r circulation infarction. Only 9 of 295 patients (3%) independent one month after stroke suffered a seizure between 1 month and 5 years (act uarial risk 4.2% (0.1% to 8.3%)). Conclusion: Stroke patients hare abo ut an 11.5% risk of single or recurrent seizures in the first 5 years after a stroke, Patients with more severe strokes or haemorrhagic stro kes are at higher risk.