Stroke: cortical involvement and acute confusional state increased the risk of early seizures.

Clinical bottom line (level 2b)

  1. A fiftieth of patients with first-ever stroke had a seizure within 48 hours of symptom onset.
  2. Patients with first-ever stroke were at an increased risk of early seizures if they had cortical involvement or acute agitated confusional state.
  3. Over a third of patients with an early seizure died in-hospital, and a sixth of patients with no seizure died in-hospital.
Arboix et al: Stroke 1997; 28: 1590-1594
Expires December 2002

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute care hospital, Spain

1220 patients (aged mean 70 years, 52% male) first-ever stroke or TIA admitted between January 1986 to December 1993, admitted within 48 hours of symptom onset

Excluded if
  • history of sever head trauma, intracerebral haemorrhage, ischaemic stroke or brain surgery



    • Factors studied:
  • early seizures
  • cortical involvement
  • acute agitated confusional state




    • Multivariate analysis was used to adjust for confounding factors.

    100% followed for 48 hours
    Outcomes studied:
  • early seizures within 48 hours of the cerebrovascular event in a patient with no history of seizures
  • in-hospital mortality in seizure group
  • in-hospital without seizure

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    early seizures 48 hours 29/1220 2.38%
    (1.52% to 3.23%)
    in-hospital mortality in seizure group 48 hours 11/29 37.93%
    (20.27% to 55.59%)
    in-hospital without seizure 48 hours 172/1191 14.44%
    (12.44% to 16.44%)

    prognostic factor for
    early seizures     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    cortical involvement 48 hours 2/792
    (0.25%)     		6.01
    (2.54 to 14.2)     		81
    (31 to 261)
    acute agitated confusional state 48 hours 25/1179
    (2.12%)     		4.44
    (1.43 to 13.8)     		15
    (5 to 113)

    • Seizures were significantly more frequent in patients with haemorrhagic stroke (4.3%), than those with ischaemic stroke (2%).

    Comments

    1. Patients with seizures were younger, more likely to have acute confusional state, cortical involvement, large stroke and involvement of the parietal, frontal, occipital and temporal lobes than patients without seizures. Lacunar syndromes were more common in patients without seizures.

    Citation

    1. Arboix A, Garcia-Eroles L, Massons JB, et al: Predictive factors of early seizures after acute cerebrovascular diseases. Stroke 1997; 28: 1590-1594
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer: Graeme Hankey

    Clinical Question.
    Patient first-ever stroke
    Intervention or Exposure presence of prognostic factors
    Comparison absence of prognostic factors
    Outcome early seizure