Adverse Effect of Early Epileptic Seizures in Patients Receiving Endovascular Therapy for Acute Stroke

Abstract

Background and Purpose— The aim of this study was to analyze epileptic seizures and their impact on outcome in patients with stroke treated with endovascular therapy. Methods— From December 1992 to December 2010 we managed 805 patients with stroke with endovascular therapy. Epileptic seizures, bleeding complications, and 3-month outcomes were recorded prospectively. Outcomes of patients with early seizures (within 24 hours of stroke onset) and patients with late seizures (>24 hours after stroke) were compared with outcomes of seizure-free patients using uni- and multivariable statistics. Results— Forty-four of 805 patients (5.5%) had seizures between stroke onset and 3-month follow-up, 26 patients early and 18 late. Outcome of patients with late seizures and seizure-free patients was similar ( P =0.144 and 0.807). Patients with early seizures had higher baseline National Institutes of Health Stroke Scale ( P =0.023) and were younger ( P =0.021) than seizure-free patients. Their mortality rate was 50% compared with 22.3% of the seizure free-patients ( P =0.003), and less patients reached a favorable outcome (modified Rankin Scale 0–2): 15.4% and 46.8%, respectively ( P =0.001). Early seizures independently predicted an unfavorable outcome ( P =0.014; OR, 4.749; 95% CI, 0.376–3.914) and increased mortality ( P =0.001; OR, 5.861; 95% CI, 0.770–2.947) in multiregression analysis. Patients with early seizures had a 1.6-fold higher risk for unfavorable outcome and a 2.2-fold higher risk for death compared with seizure-free patients. Conclusions— Seizures within 24 hours of stroke onset were associated with worse outcome in patients with stroke undergoing endovascular therapy. Our findings confirm a need for trials for prophylactic anticonvulsive treatment in patients receiving endovascular therapy for acute stroke.