Medical Technology

‘Very High’ Risk of Epilepsy One Year After Stroke

New research has shown that stroke patients are at “very high” risk for epilepsy a year later.

A large-scale registry study showed that patients who had severe intracerebral bleeding (ICH), had a nearly 10% chance of developing epilepsy and status epilepticus within the first year. Patients with severe acute Ischemic Brain Stroke (AIS) were at risk of an 8% chance of developing epilepsy, and those with mild ICH had having a 5% chance of developing.

Dr. Mads Ebbesen

“The risk of epilepsy following a stroke is extremely high, particularly after severe strokes or hematomas,” Mads Ebbesen, MD, PhD candidate, Department of Neurology, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark, said in Medscape Medical News.

Ebbesen said that even though the risk of stroke has significantly decreased over time, it is still high for those with the most severe strokes.

The findings were presented at the American Epilepsy Society (AES) 2021 Annual Meeting.

Timing Type, Severity, and Timing

The connection between stroke and epilepsy is well-known, with previous research showing that as much as half of epilepsy-related incidents that occur after age 60 are caused by stroke.

For the current study, researchers examined the time-frame of epilepsy post-stroke and the association with stroke type and severity.

The data they used was from the Danish Stroke Registry. This includes information about stroke type (ischemic, hemorhagic), severity, and risk factors. To determine epilepsy cases, researchers used the Danish National Patient Registry.

The study included 88,119 adult Danish residents (53.4 percent males) who had no epilepsy history. They had a first stroke between April 1, 2004 between December 16 and 16, 2016. The age at the time of the stroke was 69.8.

The majority of them were diagnosed with an ICH and 79157 had an AIS and 10,301 had a temporary ischemic attack.

The primary outcome was a diagnosis of epilepsy or status epilepticus. Since early seizures can be the result of an acute stroke the follow-up period began 14 days following the time when the stroke occurred.

Researchers determined the prevalence of epilepsy for each of the initial 4 years following the stroke. They categorized this by stroke type and severity using the Scandinavian Stroke Scale. Scores ranging from 0 to 15 were considered to be “very severe,” 16 to 30 as severe 31 to 45 as moderate and 46 to 58 as mild.

Risk Even After 4 Years

The results showed that 3483 epilepsy patients were diagnosed within the first four years after a stroke. Patients suffering from an ICH had the highest risk of epilepsy. The risk for epilepsy in the first year following a severe ICH was 9.8 percent (95% CI, 7.8-11.7).

The risk was close to half that (5.1 percent) in patients with mild ICH (95% CCI, 4.3-5.9). The risk was 7.8% (95 percent 95% CI, 6.8-8.7) for patients who suffer from severe AIS and 1.3% (95% 95% CI, 1.2-1.4) for those with mild AIS.

After a TIA, the probability of developing epilepsy in the first one year was 0.81 percent. “Some of this risk may be due to strokes that follow however we didn’t look into this,” said Ebbesen.

For all groups, the risk decreased over the years following the stroke, but didn’t disappear altogether. For example, the risk of very severe hematomas was 2.3% in their fourth year.

Ebbesen said, “I was surprised that there was still a significant epilepsy risk despite the fact that it had been 4 years.” “Most studies done before this one showed that epilepsy could develop following strokes, and typically occurs within the first two years.

Ebbesen pointed out that previous studies had suggested the possibility of a higher rate of epilepsy in stroke patients younger than age of 50.

He and his colleagues could not evaluate epilepsy forms or identify the location from which seizures arise.

Ebbesen said that abnormal electrical activity could be caused by brain scarring. However, this study did not look into the biological causes. He said that irritation from blood residues could trigger abnormal electrical activity in the case of hemorrhagic strokes.

“Be on the Lookout”

Jacqueline French MD, professor at New York University Langone Comprehensive epilepsy Center in New York City, commented on the findings of Medscape Media News. She stated that the study provides “important information for clinicians.”

“They should be made aware of the possibility of having seizures following stroke and, in particular, hemorrhagic stroke within the first year,” said French, who was not involved in the research.

“Physicians should inform patients at risk and their families to keep an eye out for any subtle indications of unusual behavior or feelings to ensure that seizures are not missed,” she added.

American Epilepsy Society (AES) 2021 Annual Meeting. Abstract #1.373. It was presented on December 4, 2021.

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