Seizures after Ischemic Stroke: A Matched Multicenter Study

OBJECTIVE: The purpose of this study was to identify risk factors for acute symptomatic seizures and post‐stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. METHODS: We assessed the risk factors for post‐stroke seizures using logistic or Cox regression in a multicenter study, including adults from 8 European referral centers with neuroimaging‐confirmed ischemic stroke. We compared the risk of post‐stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. RESULTS: In the overall cohort of 4,229 participants (mean age 71 years, 57% men), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and strokes caused by large‐artery atherosclerosis. Strokes caused by small‐vessel occlusion carried a small risk of acute symptomatic seizures. 6% developed post‐stroke epilepsy. Risk factors for post‐stroke epilepsy were acute symptomatic seizures, more severe strokes, infarcts involving the cerebral cortex, and strokes caused by large‐artery atherosclerosis. Electroencephalography findings within 7 days of stroke onset were not independently associated with the risk of post‐stroke epilepsy. There was no association between reperfusion treatments in general or only intravenous thrombolysis or mechanical thrombectomy with the time to post‐stroke epilepsy or the risk of acute symptomatic seizures. INTERPRETATION: Post‐stroke seizures are related to stroke severity, etiology, and location, whereas an early electroencephalogram was not predictive of epilepsy. We did not find an association of reperfusion treatment with risks of acute symptomatic seizures or post‐stroke epilepsy. ANN NEUROL 2021;90:808–820