Incidence And Predictive Factors Of Early Seizures And Late Seizures After Stroke And Correlation Research Between MRI And EEG

Background and objective: Cerebral vascular disease is the most common cause of acute symptomatic epilepsy and secondary epilepsy in adults. Post-stroke seizure and post-stroke epilepsy (PSE) often complicate the initial course of stroke. The aim of this long-term retrospective population based study is to provide comprehensive data on the risk factors of early seizures (ES) and late seizures (LS) in patients with first-ever ischemic stroke and first-ever cerebral hemorrhage. The other aim is to study the correlation between MRI and EEG in patients with seizure.Methods: This is a retrospective and long-term observational study. 1052 patients with first episode of ischemic stroke and 244 patients with first episode of hemorrhagic stroke in hospital patients were admitted and followed up from January 2011 to May 2016. According to the epileptic seizure, the patients were divided into ES group, LS group and non epileptic seizure group. Demographical, clinical,biochemical and radiological features were compared. The patients with EEG are divided into EEG/AEEG abnormality consistent with MRI lesions group and EEG/AEEG abnormality inconsistent with MRI lesions group. The number lesions of stroke, the type of stroke, the cortical area in the two groups and in abnormal and normal groups are compared.Results: 1. Of the 1052 ischemic patients,2.95% were ES (n= 31),3.52% were LS(n= 37), 93.82% were no seizures (n= 987), 2.85% were PSE (n= 30). The diameter of lesion between 2cm to 5cm (odds ratio (OR): 3.13, 95% Cl: 1.14-8.60, P = 0.027) and cortical (OR: 18.87, 95% CI: 6.90-52.63, P < 0.001) were independent predictors for ES in ischemic stroke patients. Male gender (OR: 11.77, 95% CI: 2.35-58.82, P ?0.003), cardiovascular diseases (OR: 2.93, 95% CI: 1.05-8.17, P = 0.040), the diameter of lesion between 2cm to 5cm (OR: 6.42, 95% CI: 2.41-17.10, P = 0.016)and cortical location (OR: 37.04, 95% CI: 13.16-111.11,P < 0.001) were independent risk factors for LS. 2. Of the 244 patients, 6.97% were ES (n= 17), 9.84% were LS(n= 24), 6.56% were PSE (n= 16). In multivariate logistic regression analysis, cortical(odds ratio (OR): 10.10, 95% CI: 2.04-50.00, P = 0.005) was significant predictors of ES. And male gender (OR: 2.61,95% CI: 1.07-6.33, P = 0.034),cortical location (OR:19.23, 95% CI: 8.40-43.47, P < 0.001), surgical treatment (OR: 18.54, 95% CI:1.21-284.24, P =0.036) carried the highest risk of LS. 3. In poststroke seizures,secondarily generalized tonic-clonic seizures was 50.49%, simple partial seizures 36.89% and complex partial sezures 12.62%. ES: 43.75% for simple partial seizures.LS: 12.62% for secondarily generalized tonic-clonic seizures. The most common EEG is the normal EEG (46.51%), followed by epileptic discharge (32.56%). The coincidence rate between EEG/AEEG and MRI lesions was 47.7%, and the abnormol EEG of patients with subcortical lesions was more likely consistent with MRI lesions(P<0.05). The EEG of the patients with cerebral cortical lesions and multiple sites of stroke is prone to be abnormal EEG/AEEG (P<0.05).Conclusion: 1. In stroke patients, the incidence of seizure, ES, LS and PSE were 7.95 %, 3.70%, 4.71%, 3.40%. The cortical and the diameter of lesion between 2cm and 5cm were independently predictors of ES in ischemic stroke. Male gender, cardio vascular diseases, the diameter of lesion between 2cm to 5cm and cortical predict development of LS. In hemorrhagic stroke patients, cortical damage was independent predictors of ES and LS. Male gender and surgical treatment also were independent predictors of LS. 2. The most common type of epilepsy for post-stroke seizure were secondarily generalized tonic-clonic seizures. For ES was simple partial seizures, for LS secondarily generalized tonic-clonic seizures. The coincidence rate of EEG/AEEG and the lesion site of MRI was 47.7%, and the EEG of patients with cortical lesions was more likely consistent with that of MRI. The EEG of patients with cortical lesions and multi-site stroke is more likely to be abnormal.