Stroke: haemorrhagic stroke and early seizures increased the risk of post-stroke seizures.

Clinical bottom line (level 1b)

  1. Nearly a tenth of patients who had a stroke had a post stroke seizure at 5 years.
  2. Patients were at an increased risk of a seizure within 2 years after a stroke if they had a haemorrhagic first stroke or had an early seizure.
  3. A fiftieth of patients who had a first stroke had an onset seizure.
  4. Less than a twentieth of patients who had a stroke will had a single seizure at 2 years, and the same number had recurrent seizures.
Burn et al: British Journal of Medicine 1997; 315: 1582-1587
Expires November 2002

The study

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

Setting: community-based, UK

675 patients (aged 65-74 years, 53% female) first stroke


No adjustment for confounding factors was stated.

100% followed for 2 years
Outcomes studied:
  • post stroke seizures more than 24 hours after onset of stroke - single or recurrent seizures
  • early seizure occurring within 24 hours of the onset of stroke
  • single post stroke seizure
  • recurrent post stroke seizures

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    post stroke seizures 2 years 52/658 7.90%
    (5.84% to 9.96%)
    early seizure 2 years 14/675 2.07%
    (0.99% to 3.15%)
    single post stroke seizure 2 years 23/658 3.50%
    (2.09% to 4.90%)
    recurrent post stroke seizures 2 years 25/658 3.80%
    (2.34% to 5.26%)

    prognostic factor for
    post stroke seizures     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    haemorrhagic first stroke 2 years 545/675
    (80.74%)     		10.2
    (3.70 to 27.9)     		6
    (5 to 8)
    early seizure 2 years 661/675
    (97.9%)     		7.52
    (2.46 to 23.0)     		55
    (50 to 81)

    • The probability of post-stroke seizure was higher among patients aged over 84 years.
    • 17 patients died within the first day and were not included in the post stroke seizures analysis.

    Citation

    1. Burn J, Dennis M, Bamford J, et al: Epileptic seizures after a first stroke: the Oxfordshire community stroke project. British Journal of Medicine 1997; 315: 1582-1587
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer: Graeme Hankey

    Clinical Question.
    Patient stroke
    Intervention or Exposure what are the prognostic factors
    Comparison
    Outcome epileptic fit