Incidence and predictors of post-stroke epilepsy

Background and aims Stroke is the leading cause of seizures and epilepsy in the elderly. The aim of this study was to assess the incidence of post-stroke epilepsy (PSE) based on the revised epilepsy definition of the International League Against Epilepsy (ILAE) in a population-based study and to describe possible predictors. Methods Data from the prospective population-based Erlangen Stroke Project (ESPro) were collected to describe the frequency of PSE. Patients were followed up 3, 12, and 24months after stroke. Stroke was diagnosed according to the WHO and PSE according to the new ILAE criteria. Multivariable analysis was performed to identify predictors of PSE including age, sex, stroke type, stroke severity, and comorbidities. Results From 1998 to 2006, 1815 patients with first-ever stroke were included (55.7% women; mean age 72.7years, SD 13). Patients with known (n=52) or unknown (n=331) prior-to-stroke epilepsy or no available information on post-stroke seizures (n=412) were excluded. From the remaining 1020 patients, 84 (8.2%) developed PSE within 2years after stroke. Univariate analysis demonstrated stroke severity (P<0.001) and hypertension (P<0.05) as predictors for PSE. In multivariable analysis, stroke severity remained the only independent predictor (P=0.002). Conclusions Based on the revised ILAE definition of epilepsy, the incidence of PSE was high in the ESPro. The only independent predictor for PSE was stroke severity.