Risk factors for seizures after first-time ischemic stroke by magnetic resonance imaging.

Background: Seizures are important neurological complications of ischemic stroke. There is a need to further clarify the risk factors of seizures following ischemic stroke and predict those who will require treatment.

Methods: One hundred and forty-three (143) first-time ischemic stroke patients were enrolled in this one-year (2002) retrospective study. Prognostic variables were analyzed based on the Cox's proportional hazards model after a minimum follow-up period of six years.

Results: Seizures occurred in 13 first-time ischemic stroke patients, including acute symptomatic seizures in two (1.4%) and unprovoked seizures in 11 (7.7%). Only one progressed to status epilepticus during hospitalization. After six years of follow-up, the median (inter-quartile range) Glasgow Outcome Scale (GOS) was 3 (3,4) for patients with seizures and 4 (3,4) for those without seizures. Regarding seizure control after discharge in the 13 cases, 12 were seizure-free with or without anti-epileptic drugs and one had 1-3 seizures per year. Only the presence of cortical distribution of ischemic infarction (p=0.009, OR=5.549, 95% CI=1.53-20.19) was independently associated with seizures by the Cox's proportional hazards model.

Discussion: The incidence of seizures following first-time ischemic stroke is low and may have delayed manifestation. Cortical distribution of the ischemic infarction is a risk factors for seizures.