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 ca use 22% of all cases of status epilepticus in adults. The determinants of E S and status epilepticus (SE) after stroke, however, are not well understoo d. 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. Statistica l analyses were performed using univariate and multivariate logistic regres sion 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 infa rct 0.6% (2/356), lobar infarct 5.9% (20/341), deep intracerebral hemorrhag e (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 patien ts with ES. Diabetes, hypertension, current smoking, alcohol use, age, gend er, and race/ethnicity were not significant determinants of ES. In a subgro up of patients who had an NIH strobe scale (NIHSS) score recorded, NIHSS sc ore was not an independent predictor of ES in multivariate analysis. After accounting for stroke severity, ES was not a predictor of 30-day case fatal ity. Conclusions: Lesion location and stroke subtype are strong determinant s 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.