Long-term epilepsy after early post-stroke status epilepticus

Abstract

Purpose: The risk of developing epilepsy at long term after post-stroke status epilepticus (PSSE)is unknown. We aimed to evaluate post-stroke epilepsy (PSE)after early-onset PSSE and its associated factors. Method: All consecutive patients with early-onset PSSE and no history of epilepsy admitted to our hospital between February 2011 and April 2017 were included. We analysed status epilepticus (SE)and stroke-related factors in relation to the development of PSE. Results: Fifty patients with early-onset PSSE were analysed. Mean age was 74.8 ± 14.3 years and 22 (44%)were women. Median NIHSS at the onset of PSSE was 11 (IQR 4–16)and median PSSE duration was 12 h (IQR 4.69–57). Median follow-up was 214 days (IQR 7.5–747). Ten patients (20%)developed PSE at a median delay of 153 days (IQR 20–334). On multivariate analysis, NIHSS > 4 (p = 0.019; hazard ratio: 15.757; 95% CI, 1.564–158.799)and PSSE > 16 h (p = 0.023; hazard ratio: 7.483; 95% CI, 1.325–42.276)were independently associated with a greater risk of PSE. The mean time from PSSE to onset of recurrent seizures was 142 days (IQR 19–153)in patients with PSSE > 16 h and 310 days (IQR 147–480)in PSSE < 16 h (p = 0.094). Conclusions: NIHSS score >4 at the stroke presentation and PSSE duration >16 h may predict of PSE in patients with early-onset PSSE. Recurrence may develop earlier in PSSE patients with longer duration of the episode.