Introduction: Despite affecting a minority of patients, post-stroke seizure (PSS) is the leading cause of seizures and epilepsy in adults over age 60. Such seizures are an important biomarker of adverse clinical outcomes and cognitive decline after stroke. While prognostic models such as the SeLECT 2.0 score assess risk for PSS after ischemic stroke (IS) based on location, severity, and mechanism, it is unknown how chronic systemic co-morbidities affect the risk. Among these, chronic kidney disease (CKD) is highly prevalent in aging patients with influence on electrolyte regulation and metabolite excretion that can relate to provoked seizures; yet there has not been a rigorous investigation of the effect of kidney function on PSS to date. We studied associations between measures of kidney function and risk of PSS in ischemic stroke survivors in the Atherosclerosis Risk in Communities (ARIC) cohort study. Methods: Participants in the ARIC prospective cohort free of IS at baseline (1987-1989) were followed for stroke incidence and subsequent PSS through 12/31/2022. Among 15,100 ARIC participants, 1,287 incident ischemic stroke were identified for study inclusion, with 80 patients (6%) subsequently diagnosed with PSS. Univariate analysis with chi-square statistic or t-test was completed to identify how eGFR levels (exposure) and covariates correlated with the outcome of PSS. Cox regression models were fitted to identify time-to-event associations for PSS within 5 years, accounting for multiple covariates (Figure 1). eGFR from the visit closest to indicent stroke was analyzed around a threshold of > or < eGFR=60. Analysis was confined to 5 years, when the vast majority of seizures that can be clearly associated with stroke occur. Results: Differences between the non-PSS and PSS group were observed as proportions of eGFR<60 (13% vs. 26% respectively, p<0.01) and minor strokes (NIHSS ≤5, 66% vs. 50% respectively, p<0.01) (Table 1). 5-year cumulative incidence of PSS was higher for eGFR<60 compared with eGFR≥60 (Figure 1) and the adjusted risk ( HR, 95% CI) per year to seizure for eGFR<60 compared with eGFR≥60 was 2.8 (95% CI: 1.6-4.8 ). Conclusions: CKD, a common chronic co-morbidity in IS patients, is modestly, but significantly, associated with higher risk of PSS. Our results will guide further research to learn if seizure prophylaxis in carefully selected patients may mitigate the risk of post-stroke seizure and epilepsy .
Kelly et al. (Thu,) studied this question.