Background: Post-stroke epilepsy (PSE) is a major contributor to the rising epilepsy burden among older individuals. Early post-stroke seizures (EPSS), a risk factor for PSE, may be affected by changing treatment patterns such as reperfusion in ischemic stroke, but it is unknown whether their prevalence is changing. We used a representative population-based study of stroke to examine the prevalence and trends of EPSS from 2005 to 2020. Methods: The Greater Cincinnati Northern Kentucky Stroke Study is an ongoing stroke surveillance study in the Greater Cincinnati region. Hospitalized strokes were ascertained and adjudicated by stroke physicians in calendar years 2005, 2010, 2015 and 2020. Stroke subtypes were categorized as ischemic strokes (IS), ischemic strokes with hemorrhagic transformation (IS-HT) and primary hemorrhagic stroke (HS, including intracerebral and subarachnoid hemorrhages). The presence of seizures was determined by chart review. EPSS were defined as all clinical or electrographic seizures that occurred during the pre-hospital setting or the initial hospitalization. Patients with history of seizures/epilepsy were excluded. Multivariable logistic regression was used to estimate the effect of study year on EPSS rate after adjusting for age, sex, and race; a second model also adjusted for stroke subtype. Results: We identified 10,312 stroke patients without history of epilepsy across all study periods, of whom 2375 (23.0%) were Black and 5552 (53.8%) were female. Demographics and subtypes are shown in Table 1; there was an increase in the percentage of individuals with IS-HT over time (from 4% in 2005 to 8% in 2020, trend P<0.001). Across all study periods, 432 (4.2%) individuals developed EPSS. The rate of EPSS was stable over time in a model adjusted for age, sex and race (overall effect of study year p=0.96, Table 2). In the second model, stroke subtypes were added with similar results (Table 2). Among subtypes, HS patients had the highest risk of EPSS (OR=4.11 compared to IS, 95% CI 3.34, 5.06, P<0.001), followed by IS-HT patients (OR=2.48 compared to IS, 95% CI 1.73, 3.56, P<0.001). Conclusions: In a representative population-based stroke study, the prevalence of EPSS was 4.2%, which has not changed over time. Patients with HS were at highest risk for EPSS, followed by those with IS-HT. The increase in IS-HT over time may be related to a rise in thrombectomy rates and increased MRI detection. More research on the growing burden of PSE is needed.
Sarkar et al. (Thu,) studied this question.