SEIZURES IN ACUTE STROKE - PREDICTORS AND PROGNOSTIC-SIGNIFICANCE - THE COPENHAGEN STROKE STUDY

Background Despite the common occurrence of seizures during the early phase of stroke (ES), the effect of ES on prognosis is not known. We d etermined the relationships between ES and stroke outcome and identifi ed predictors of ES. Methods In this community-based study, we prospec tively and consecutively studied 1197 patients with acute stroke. We d etermined the number and type of seizures, initial stroke severity, in farct size, mortality, and outcome in survivors. Stroke severity was m easured on admission, weekly, and at discharge using the Scandinavian Stroke Scale (SSS). Multiple logistic and linear regression outcome an alyses included relevant confounders and potential predictors, includi ng age, gender, stroke severity on admission, atrial fibrillation, isc hemic heart disease, diabetes, blood glucose level on admission, claud ication, and hypertension. Results Fifty patients (4.2%) had seizures within 14 days of the stroke. In the multivariate analyses, only initi al stroke severity was related to ES; stroke type and lesion localizat ion were not related. For each 10-point increase in stroke severity (S SS score), the relative risk of ES increased by a factor of 1.65 (95% confidence interval, 1.4 to 1.9) (P<.0001). ES did not influence the r isk of death during hospital stay (P=.56). In survivors, ES was relate d to a better outcome, equivalent to an increased SSS score of 5.7 poi nts (SE [b]=1.8; P=.002). Conclusions The decisive factor of ES was in itial stroke severity. ES per se was not related to mortality. Surpris ingly, in survivors, ES predicted a better outcome. We explain this fi nding by a relatively larger ischemic penumbra in patients who have an ES after a stroke.