We studied the influence of very early seizures (within 48 h of stroke onset) on in-hospital mortality in a cohort of 452 consecutive patients with atherothrombotic infarction. These patients were selected from 2,000 consecutive acute stroke patients registered in a prospective hospital-based stroke registry in Barcelona, Spain. A comparison of data between the nonseizure (n = 442) and seizure (n = 10) groups was made. Predictors of very early seizures were assessed by multivariate analysis. The in-hospital mortality rate was significantly higher in atherothrombotic stroke patients with very early seizures than in those without seizures (70 vs. 19.5%, p < 0.001). Independent predictors of in-hospital mortality included very early seizures, congestive heart failure, atrial fibrillation, 85 years of age or older, altered consciousness, dizziness, parietal and pons involvement, and respiratory and cardiac complications. After multivariate analysis, atherothrombotic infarction of occipital topography and decreased consciousness appeared to be independent predictors of atherothrombotic stroke with very early seizures. Very early seizures constitute an important risk factor for in-hospital mortality after atherothrombotic stroke.

Keywords:
Atherothrombotic infarction, Epilepsy, Early seizures, Stroke, acute, Stroke outcome
1.
Bladin ChF, Alexandrov AV, Norris JW: Seizures after stroke; in Fisher M, Bogousslavsky J (eds): Current Review of Cerebrovascular Diseases, ed 2. Philadelphia, Current Medicine, 1996, pp 107–117.
2.
Reith J, Jorgensen HS, Nakayama H, Raaschou HO, Olsen S: Seizures in acute stroke: Predictors and prognostic significance. The Copenhagen Stroke Study. Stroke 1997;28:1585–1589.
3.
Dávalos A, de Cendra E, Molins A, Ferrandiz M, Lopez-Pousa S, Genis D: Epileptic seizures at the onset of stroke. Cerebrovasc Dis 1992;2:327–331.
4.
Pinto AN, Canhao P, Ferro JM: Seizures at the onset of subarachnoid haemorrhage. J Neurol 1996;243:161–164.
5.
Nunes B, Barros J, Correia M, Castro Lopes J: Epilepsy and cerebrovascular diseases in an outpatient clinic. Cerebrovasc Dis 1994;4:96–100.
6.
Shinton RA, Gill JS, Melnick SC, Gupta AK, Beevers DG: The frequency, characteristics and prognosis of epileptic seizures at the onset of stroke. J Neurol Neurosurg Psychiatry 1988;51:273–276.
7.
Fisher CM: Lacunar strokes and infarcts: A review. Neurology 1982;32:871–876.
8.
Broderick JP, Phillips SJ, O’Fallon M, Frye RL, Whisnant JP: Relationship of cardiac disease to stroke occurrence, recurrence and mortality. Stroke 1992;23:1250–1256.
9.
Arboix A, Vericat MC, Pujades R, Massons J, García-Eroles L, Oliveres M: Cardioembolic infarction in the Sagrat Cor-Alianza Hospital of Barcelona Stroke Registry. Acta Neurol Scand 1997;96:407–412.
10.
Arboix A, Alvarez-Sabín J, Soler L for the Cerebrovascular Study Group of the Spanish Society of Neurology: Nomenclatura de las enfermedades vasculares cerebrales. Neurologia 1998(suppl 1):1–10.
11.
Anonymous. Special Report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases. Part 3. Stroke 1990;21:637–676.
12.
Arboix A, Comes E, Massons J, García L, Oliveres M: Relevance of early epileptic seizures for in-hospital mortality in acute cerebrovascular disease. Neurology 1996;47:1429–1435.
13.
Arboix A, García-Eroles L, Massons J, Oliveres M, Comes E: Predictive factors of early epileptic seizures after acute cerebrovascular disease. Stroke 1997;28:1590–1594.
14.
Arboix A, Oliveres M, Massons J, Pujades R, García-Eroles L: Early differentiation of cardioembolic from atherothrombotic cerebral infarction: A multivariate analysis. Eur J Neurol 1999;6:677–683.
15.
Crozier S, Lehéricy S, Verstichel P, Masson C, Masson M: Transient hemiballism/hemichorea due to an ipsilateral subthalamic nucleus infarction. Neurology 1996;46:267–268.
16.
Saposnik G, Caplan LR: Convulsive-like movements in brainstem stroke. Arch Neurol 2001;58:654–657.
17.
Anonymous. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981;22:489–501.
18.
Silver FL, Norris JW, Lewis AJ, Hachinski VC: Early mortality following stroke: A prospective review. Stroke 1984;15:492–496.
19.
Hosmer DW, Lemershow S: Goodness of fit tests for the multiple logistic regression model. Commun Stat 1980;A9:1043–1069.
20.
Hosmer DW, Lemershow S: Applied Logistic Regression. New York, John Wiley, 1989, pp 25–37.
21.
Norusis MJ: SPSS Advanced Statistics Student Guide. Chicago, SPSS, 1990.
22.
Dixon WJ: BMDP Statistical Software Manual, 1981. Berkeley, University of California Press, 1981, pp 330–344.
23.
Ossermann M: Crises épileptiques et épilepsies d’origine vasculaire: caractéristiques cliniques, électroencephalographiques et scannographiques. Rev Neurol (Paris) 2002;158:256–259.
24.
Milandre L, Broca P, Gabriel B, Khalil R: Les crises épileptiques secondaires aux accidents cérébrovasculaires. Ann Med Intern 1993;144:28–34.
25.
Kilpatrick ChJ, Davis SM, Tress BM, Rossiter SC, Hopper JL, Vandendriesen ML: Epileptic seizures in acute stroke. Arch Neurol 1990;47:157–160.
26.
Giroud M, Gras P, Fayolle H, André N, Soichot P, Dumas R: Early seizures after acute stroke: A study of 1,640 cases. Epilepsia 1994;35:959–964.
27.
Sung CY, Chu NS: Epileptic seizures in thrombotic stroke. J Neurol 1990;237:166–170.
28.
Cocito L, Favale E, Reni L: Epileptic seizures in cerebral arterial occlusive disease. Stroke 1982;13:189–195.
29.
Arboix A, Comes E, Massons J, García L, Oliveres M: Early epileptic seizures after acute cerebrovascular disease (abstract). Cerebrovasc Dis 1995;5:257.
30.
Arboix A, García-Eroles L, Massons J, Oliveres M: Predictive clinical factors of in-hospital mortality in 231 consecutive patients with cardioembolic cerebral infarction. Cerebrovasc Dis 1998;8:8–13.
31.
Lancman ME, Golimstok A, Norscini J, Granillo R: Risk factors for developing seizures after a stroke. Epilepsia 1993;34:141–143.
32.
Asconapé JJ, Penry JK: Poststroke seizures in the elderly. Clin Geriatr Med 1991;7:483–492.
33.
Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Coté R, Lebrun L, Pirisi A, Norris JW, for the Seizures After Stroke Study: Seizures after stroke. A prospective multicenter study. Arch Neurol 2000;57:1617–1622.
34.
Rumbach L, Sablot D, Berger E, Tatu L, Vuillier F, Moulin T: Status epilepticus in stroke. Report on a hospital-based stroke cohort. Neurology 2000;54:350–354.
35.
Velioglu SK, Özmenoglu M, Boz C, Alioglu Z: Status epilepticus after stroke. Stroke 2001;32:1169–1172.
36.
Voll Ch L, Auer RN: Postischemic seizures and necrotizing ischemic brain damage: Neuroprotective effect of postischemic diazepam and insulin. Neurology 1991;41:423–428.
37.
Tan WKM, Williams ChE, Gunn AJ, Mallard CE, Gluckman PD: Suppression of postischemic epileptiform activity with MK-801 improves neural outcome in fetal sheep. Ann Neurol 1992;32:677–682.
38.
Lynch MW, Rutecki PA, Sutula ThP: The effects of seizures on the brain. Curr Opin Neurol 1996;9:97–102.
39.
Blennow G, Brierley JB, Meldrum BS, Siesjö BK: Epileptic brain damage. The role of systemic factors that modify cerebral energy metabolism. Brain 1978;101:687–700.
40.
De Reuck J, Decoo D, Algoed L, Boon P, Van Maele G, Lemahieu I, Strijckmans K, Goethals P: Epileptic seizures after thromboembolic cerebral infarcts: A positron emission tomographic study. Cerebrovasc Dis 1995;5:328–333.
41.
Hankey GJ: Prolonged exacerbation of the neurological sequelae of stroke by post-stroke partial epileptic seizures. Aust NZ J Med 1993;23:306.
42.
Bougousslavsky J, Martin R, Regli F, Despland PA, Bolyn S: Persistent worsening of stroke sequelae after delayed seizures. Arch Neurol 1992;49:385–388.
43.
Soffer D, Melamed E, Assaf Y, Cotev S: Hemispheric brain damage in unilateral status epilepticus. Ann Neurol 1986;20:737–740.
44.
So EL, Annegers JF, Hauser WA, O’Brien PC, Wishnant JP: Population-based study of seizure disorders after cerebral infarction. Neurology 1996;46:350–355.
45.
Gilad R, Lampl Y, Eschel Y, Sadeh M: Antiepileptic treatment in patients with early postischemic stroke seizures: A retrospective study. Cerebrovasc Dis 2001;12:39–43.
46.
Arboix A, García-Eroles L, Massons J, Oliveres M, Targa C: Acute stroke in very old people: Clinical features and predictors of in-hospital mortality. J Am Geriatr Soc 2000;48:36–41.
47.
Broderick JP, Phillips SJ, O’Fallon WM, Frye RL, Whisnant JP: Relationship of cardiac disease to stroke occurrence, recurrence and mortality. Stroke 1992;23:1250–1256.
48.
Pinto AN, Melo TP, Lourenço ME, Leandro MJ, Brázio A, Carvalho L, Soares Franco A, Ferro JM: Can a clinical classification of stroke predict complications and treatment during hospitalization? Cerebrovasc Dis 1998;8:204–209.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.