EPILEPTIC SEIZURES AT THE ONSET OF STROKE

Controversies exist concerning the frequency of early epileptic seizures in different types of stroke. The aim of this work was to analyze the incidence of epileptic seizures at the onset of stroke, the factors related to seizures, and the prognosis of such seizures. A total of 1,000 patients included in a prospective data bank of cerebrovascular diseases in Girona were studied. Cranial CT scans were carried out in 90.5 % of the series. Fifty patients (5 %) had epileptic seizures at the onset or during the first 48 h of stroke. When the lesions involved the cortical region of the cerebral lobes, seizures occurred in 15.6 % of the hemorrhages, 19.2 % of the hemorrhagic infarcts and 6.2 % of the ischemic infarcts (p = 0.02). The incidence of seizures was similar in superficial ischemic infarcts of thrombotic or embolic origin. Thirty-two percent of patients with seizures and 19 % of those without seizures died during hospitalization (p = 0.02). Epileptic seizures did not constitute an independent predictive factor of bad prognosis in the multiple regression analysis after adjusting the model for age, lesion extent and loss of consciousness. In conclusion, epileptic seizures at the onset of stroke are more frequent in hemorrhagic lesions. Their incidence is greater in large superficial lesions that reduce the level of consciousness and cause cerebral herniation, these being the factors leading to poor outcome.