Early seizures in stroke - frequency, risk factors, and effect on patient outcomes in a tertiary center in Saudi Arabia

Objectives: To determine the frequency, risk factors, and outcomes of Early seizure (ES) after stroke in a Saudi cohort. Methods: A retrospective study was conducted in King Abdulaziz Medical City, Riyadh, KSA. All stroke patients whether they had first or recurrent stroke were included from February 2016 to December 2017. Data were analyzed using the SAS software version 9.4. Results: Out of 665 patients, 456 (68.6%) were males and 564 (85.2%) were Saudis; the cohort's mean age was 60.6 +/- 12.6 years. Fifty-one (7.7%) patients had ES, which were more common in women (p=0.0123). Loss of consciousness (p=0.0402) and confusion (<0.0007) were associated with ES, whereas unilateral weakness (p=0.001) and unilateral numbness (p=0.0317) at presentation decreased the risk of ES. Vascular risk factors did not differ between patients with and without ES. Hemorrhagic stroke was associated with ES (p=0.0054), whereas patients with small vessel disease were less likely to develop ES (p=0.0013). Patients with ES had more severe stroke (NIHSS >5) (p=0.0139), more ICU admissions (49% vs. 26.2%; p.0.0005), longer length of hospital stay (44.9 days vs. 24.9 days; p=0.0018), higher rates of stroke-related complications (e.g. recurrent stroke, pulmonary embolism, hospital acquired infections, and need for tracheostomy and gastrostomy tube placement) (p <= 0.0001), and were likely to be more severely disabled defined as mRS 3-5 at discharge (47.7% vs. 40.8%; p=0.0055) or to die in hospital (11.8% vs. 4.6%; p <= 0.0001). Conclusion: The ES after stroke were common in our cohort. Increased stroke severity and confusion were independent predictors of ES. The ES were associated with higher rates of in-hospital complications, longer length of hospital stay, and worse outcomes at discharge.

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Summary: This study investigated the frequency, risk factors, and outcomes of early seizures after stroke in a Saudi cohort. Results showed that early seizures were associated with female gender, loss of consciousness, and confusion, while patients with small vessel disease were less likely to develop early seizures. Patients with early seizures had more severe strokes, higher rates of in-hospital complications, longer hospital stays, and worse outcomes at discharge.