Post-stroke seizure (PSS) following intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA): A retrospective study

Abstract Background Recombinant tissue plasminogen activator (rtPA), the gold standard treatment of acute ischemic stroke, can reportedly result in seizures, known as post-stroke seizure (PSS). PSS is categorized as early PSS (EPSS), occurring within the first week of stroke onset, and late PSS (LPSS), occurring after the first week of stroke onset. Therefore, we aimed to evaluate the incidence of PSS after intravenous thrombolysis (IVT) with rtPA and to identify the potentially associated risk factors. Methods This retrospective cohort study included 955 patients who were admitted between January 2017 and October 2018. Demographics, medical records, and paraclinical data were recorded and analyzed. Results Out of the 955 patients included, 176 (18.42%) had received rtPA, of which 93 (69.88%) were male. Focal to bilateral tonic-clonic seizure was the most frequent seizure type in our study. We found that the use of rtPA was not significantly associated with the incidence of PSS. EPSS was significantly associated with a positive history of ischemic stroke (P = 0.019), cortical involvement (P = 0.002), cardioembolic stroke (P = 0.013), and HT (P = 0.009). LPSS was significantly associated with DM (P = 0.021), cortical involvement (P = 0.049) and higher mRS scores (P = 0.007). Conclusions rtPA did not significantly impact the incidence of PSS. Further research is needed to strengthen the body of evidence for the relationship between IVT with rtPA and PSS and to identify the associated risk factors.