Abstract
Background:
Acute ischemic stroke (AIS) is the most commonly identified cause of acute seizures and secondary epilepsy in adults. There is a lack of large data base study regarding the predictors and outcome of epilepsy in post-AIS patients.
Methods:
We performed a retrospective analysis of the Nationwide Inpatient Sample (years 2003-2013) in adult hospitalizations for AIS with epilepsy to compare the outcomes (Mortality, Risk of Death and Loss of Function, discharge status) using ICD-9-CM codes. We performed weighted analyses using chi-square, t-test, and Cochran Armitage trend test. Multivariate survey logistic regression was done to evaluate post-AIS epilepsy outcomes and predictors.
Results:
Amongst 4,566,282 AIS hospitalizations, 271,519 (5.9%) had seizure or epilepsy. There was a decrease in trend (6.3% in 2003 to 5.9% in 2013; p<0.001). The mean length of stay was longer for 2 days (p<0.001) and cost of hospitalization was higher by $12,754 (p<0.001) in post-AIS epilepsy patients compared to those without. They had significant higher mortality rates (9.1% vs 5.1%; aOR: 1.93; 95%CI: 1.84-2.01), adverse discharge event (65.2% vs 58.2%; aOR: 1.34; 95% CI: 1.31-1.38), loss of function (56.8% vs 37.8%; aOR: 2.29; 95%CI: 2.23-2.36), and risk of death (38.7% vs 22%; aOR: 2.35; 95%CI: 2.28-2.41) as compared to those without epilepsy. Predictors for post-AIS epilepsy were Afro-American (aOR: 1.42; 95%CI: 1.38-1.47), CNS disorders (aOR: 7.56; 95%CI: 6.91-8.28), AV malformation (aOR: 2.35; 95%CI: 1.81-3.06), drug abuse (aOR: 1.81; 95%CI: 1.14-2.87), alcohol (aOR: 1.36; 95%CI: 1.28-1.44), amyloidosis (aOR: 1.68; 95%CI: 1.13-2.49), AIDS (aOR:1.25; 95%CI:1.03-1.52), SLE (aOR: 1.52; 95%CI: 1.32-1.74), hemorrhagic transformation (aOR: 1.60; 95%CI: 1.46-1.75), hypercoagulable state (aOR: 1.38; 95%CI: 1.23-1.55), and H/O TIA (aOR: 1.24; 95%CI: 1.18-1.30). Treatment with aspirin (aOR: 0.89; 95%CI: 0.84-0.94), rt-PA (aOR: 0.71; 95%CI: 0.66-0.77), and mechanical thrombectomy (aOR: 0.68; 95%CI: 0.53-0.87) were significantly protective against post-AIS epilepsy.
Conclusion:
Early identification of risk factors and prompt management with antiepileptic prophylaxis in such patients help to improve the chance of survival amongst stroke patients.