Analysis Of The Risk Factors And Clinical Characteristics Of Seizures After Acute Ischemic Stroke

Background:At present, stroke has been the commonest cause of mortality in our country. It includes ischemic stroke and hemorrhagic stroke, and the former is the most common type. Stroke is the most common cause of seizures, especially in the elderly. Meanwhile seizures will affect the early treatment and worsen the prognosis of patients with stroke. Both of stroke and seizures are heavy burden for patients, families and society. Currently, there are many studies doing research about the incidence rate, risk factors and clinical characteristics of post-ischemic stroke seizures in the world. However, this varies significantly among studies due to many factors including differences in study design, simple size, and duration of follow-up. In order to provide evidence for clinical prevention, rehabilitation and health education, there are still many problems about post-ischemic stroke seizures need to be further studied.Objectives:To assess the incidence, predictive factors and clinical characteristic of seizures after acute ischemic stroke in elderly people.Methods:We retrospectively investigated all patients with initial acute ischemic stroke in Department of Neurology, Affiliated Zhongda Hospital of Southeast University from July 2013 to June 2015. The enrolled patient’s demographic data (gender and age), history of hypertension and diabetes, cerebral atrophy, cortical involvement, serum triglyceride and serum total cholesterol, glycosylated hemoglobin level, the onset time of first seizure after stroke and the type of seizure. The longest time of follow-up was 30 months. According to the occurrence time after acute ischemic stroke, seizures were divided into early seizures and late seizures.Early onset seizures were defined when they appeared within the first 14 days after stroke onset. Seizures were distinguished as being partial and generalized, the former consists of simple partial and complex partial. Early seizures were assessed by chart review and late seizures were retrospectively recorded at telephone follow-up visit. Finally, a total of 900 patients with acute ischemic stroke were enrolled in our study, among them 35 patients developed seizure. The risk factors and clinical features of acute ischemic stroke were analyzed and summarized. Multivariate logistic analysis was made after univariate analysis.Results:Among the 900(64% men, mean age 69.87±12.16 years) initial acute ischemic patients included,35(57.1% men, mean age 74.06±10.47 years) developed seizure. The incidence of seizure was 3.8%. Seizures were associated with older age(p=0.038)and cortical involvement(p=0.000).And cortical involvement were independently associated with seizures. It was also found that ischemic stroke patients with cortical involvement in left frontal lobe (p=0.007) and right temporal lobe (p=0.039) were more likely to have seizures, and after multiple regression analysis both of them still had significant statistical difference.The gender, hypertension, diabetes mellitus, brain atrophy, serum triglyceride, serum total cholesterol, including glycosylated hemoglobin (HbAlc), did not influence the risk of seizures after acute ischemic stroke. Compare with late seizures, early seizures occurred only in patients with high HbAlc.Conclusion:Seizures are rarely a major problem in elder acute ischemic stroke survivors. Our data show that seizures are associated with older age and cortical involvement, and cortical involvement is independent risk factor for seizures. Patients with cortical involvement in left frontal lobe and right temporal lobe in were much easier tohave secondary seizures. Early seizures occur in particular in patients with high HbAlc.