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Early seizures in first‐ever acute stroke patients in I ndia: incidence, predictive factors and impact on early outcome
Author(s) -
Goswami R. P.,
Karmakar P. S.,
Ghosh A.
Publication year - 2012
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2012.03782.x
Subject(s) - medicine , stroke (engine) , hazard ratio , confidence interval , epilepsy , acute stroke , incidence (geometry) , pediatrics , tissue plasminogen activator , mechanical engineering , psychiatry , engineering , physics , optics
Background and purpose Stroke‐associated early seizures ( ES ) often complicate the initial course of acute stroke. This study intended to estimate the rate of and the predictive factors for ES and the impact of ES on the clinical outcome in patients with first‐ever acute stroke. Materials and methods Consecutive patients with first‐ever acute stroke admitted in the D epartment of M edicine from J une 2010 to D ecember 2011 were prospectively included. ES were defined as seizures occurring within 7 days from acute stroke. Patients with history of epilepsy, transient ischaemic attack, subarachnoid haemorrhage and cerebral venous thrombosis were excluded. Clinical outcomes were measured under the subheadings of mortality and disability at discharge, according to modified Rankin score. Results Of the 441 (56.92% male patients, median age 55 years, 49.43% had haemorrhagic stroke) patients, 79 (17.91%, 95% confidence interval ( CI ): 14.61–21.78%) suffered from ES . At discharge, 37.64% were disabled, and 19.5% were dead. In multivariate analysis, alcoholism, NIHSS at admission, haemorrhagic stroke and cortical location were significant predictors of ES . Thirty‐day mortality was predicted by NIHSS at admission [hazard ratio ( HR ): 1.14, 95% CI : 1.11–1.18, P < 0.001], history of hypertension ( HR : 3.79, 95% CI : 2.1–6.85, P < 0.001), history of alcoholism ( HR : 2.43, 95% CI : 1.49–3.95, P < 0.001) and early seizure ( HR : 2.58, 95% CI : 1.54–4.34, P = 0.001). Conclusions Early seizures occurred in about 18% acute stroke patients. Alcoholism, haemorrhagic stroke, cortical and severe strokes predict development of ES . ES are an independent important risk factor for early mortality.