Incidence of Seizures in Stroke Patients

Gauthaman, C S (2006) Incidence of Seizures in Stroke Patients. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Stroke is one of the most common causes of seizures in elderly. The relation between seizures and stroke was recognized more than a century ago by John Hughling Jackson. The reported incidence of seizures after stroke varies from 4.1% - 12.5%. This is related to different study population and follow up times. The incidence of post stroke seizures in India is 13%. Despite the relatively low incidence of seizures after cerebral stroke, Post stroke seizures is one of the most common causes of seizures due to the high incidence of stroke. A seizure may occur before, at the onset of, or weeks to months after a stroke. Hence the onset of seizures in adult or elderly population may be a warning sign for further stroke and warrants a study of patients cerebral circulation. An important risk factor for development of seizures after stroke is the involvement of cerebral cortex. Hemorrhagic strokes result in seizures more frequently than do Ischemic strokes. The presence of precipitating factors like hyperglycemia, hypoglycemia, hypernatremia, hypocalcaemia, hypomagnesaemia, renal failure and infections – increase the chance of seizures. Atrial fibrillation and diabetes are found to be associated with increased risk of early seizures. There is a strong link between stroke severity and risk of seizures after stroke. The risk is very low in mild strokes. AIM: Both early and late onset post stroke seizures left sided cortical infarcts, increased stroke severity and recurrent strokes are the risk factors for post stroke late epilepsy. The present study was conducted prospectively to define the clinical features, CT findings and EEG correlation of stroke patients with seizures. MATERIALS AND METHODS: This study was carried out in the Department of General medicine and the Department of Neuromedicine at the Govt. Stanley Hospital, Chennai, India from August 2005 to Jan 2006. The patients in the age group of 30 to 88 yrs with the following criteria were included in the study. Inclusion Criteria: 1. Diagnosis of stroke, 2. With or without seizures. Exclusion Criteria: 1. Previous seizures, 2. Previous brain surgery, 3. Head trauma, 4. Sub arachnoid hemorrhage, 5. Aneurysm, tumor, 6. AVM related bleed, 7. Significant metabolic abnormality, 8. Septicemia. All patients were interviewed using a structured proforma. This includes a detailed history regarding stroke, type of stroke, time and nature of onset, associated with seizures, level of consciousness etc. A detailed past history regarding SHT, DM, RHD were recorded. A detailed clinical examination was performed. The biochemical investigations done in these patients include blood sugar, urea, creatinine, serum electrolytes and LFT. Chest X ray and ECG were taken for all patients. Computerized tomography scan of brain was done to all patients with special emphasize to look for infarct, hemorrhage and the site of lesion. EEG was taken for nearly 50% of patients who presented without seizures and eight out of nine patients who presented with seizures. RESULTS: A total of eighty-one patients who satisfied the inclusion criteria between the ages of 30 and 88 years were included in the study. 17 (21%) of the eighty-one patients were females and 64 (79%) were males. The patients were grouped based on the CT scan findings. There were sixty patients (74%) in group I, seven (8.6%) in group II and fourteen (17.3%) patients in group III. Analysis of Stroke Patients with Seizures: Nine patients (6 males and 3 females) in age range of 47 yrs to 75 yrs (mean age 61 yrs) from 81 patients of stroke who fulfilled the selection criteria had seizures. The incidence of seizures is 11.1%. 5 (55.6%) of the 9 patients who had seizures had infarct in brain, 3(33.3%) patients had hemorrhage in the brain and 1(11.1%) patient showed normal study in CT scan. None of the 5 patients who showed infarct in CT scan brain had an evidence for embolic stroke (vascular disease, atrial fibrillation and myocardial infarction). Of the nine patients who had seizures 5 patients showed left sided cortical involvement 3 pts showed right-sided cortical involvement one showed bilateral cortical involvement. All the 5 patients who had an infarct in the brain showed involvement of cortical areas with or without sub cortical region involvement, but no patient showed pure sub cortical lesion on cranial CT. 2 of the hematoma were in the cerebral cortex and 1 was primarly in the capsulo ganglionic region. None of the hematoma showed an evidence of intraventricular extension. 6 patients (67%) had early immediate seizures (i.e. within 24 hrs of onset of stroke and 3 (33%) had late onset seizures. In patients with early immediate seizures 2(33%) of them presented with focal seizures, 2(33%) presented with GTCS, 1 with focal becoming secondary generalized (17%) and one (17%) patient presented with status epilepticus. Of the 3 patients who presented with late onset seizures 2(67%) had GTCS and 1(33%) had focal seizure, none of 3 patients had history of recurrent seizures. EEG recordings were normal in 6 of them, 2 of them showed diffuse slowing, and in one patient EEG cannot be recorded. None of the patients showed focal slowing or epileptiform discharges. No specific EEG pattern was seen with early versus late seizures. CONCLUSION: 1. Post stroke early onset seizures occur within two weeks of stroke onset, while late onset seizures occur after two weeks. 2. The incidence of seizures in this study is 11.1% 3. The incidence of early onset seizures is 7.4% 4. The incidence of late onset seizures is 3.7% 5. The incidence of focal seizures in early onset post stroke seizures is 33%. 6. The incidence of GTCS (including status epilepticus) in early onset post stroke seizures is 50%. 7. EEG recordings were normal in 78% of patients while 22% showed diffuse slowing. 8. The involvement of cerebral cortex has been emphasized in the pathogenesis of epilepsy caused by stroke. In the present study 100% of infarctions leading to seizure involved cerebral cortex with or without involvement of subcortical region. 9. 67% of hematomas were localized exclusively to the cortical region. 10. 55% of patients showed left side cortical involvement while 33.3% showed right side cortical involvement, and 11.1% showed bilateral involvement.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Incidence ; Seizures ; Stroke Patients.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 03:08
Last Modified: 23 Mar 2018 03:08

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