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Research paper
The prognosis of acute symptomatic seizures after ischaemic stroke
  1. Thomas Leung,
  2. Howan Leung,
  3. Yannie O Y Soo,
  4. Vincent C T Mok,
  5. K S Wong
  1. Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
  1. Correspondence to Dr Howan Leung, Division of Neurology, Department of Medicine and Therapeutics, 9/F Clinical Science Building, Prince of Wales Hospital, Shatin, NT, Hong Kong; howanleung{at}


Objective Acute symptomatic seizure (AS) after ischaemic stroke is defined as a seizure occurring ≤7 days of the stroke. There remains a lack of information on the prognosis of AS after ischaemic stroke and how it should be treated.

Methods We prospectively recruited patients after their incidents of ischaemic stroke from a population-based stroke registry. Stroke aetiology was defined according to Trial-of-ORG-10172 in acute-stroke treatment (TOAST). Patients were examined for any transient complete-occlusion with recanalisation (TCOR) and haemorrhagic transformation. The seizure outcomes were (1) acute clustering of seizures ≤7 days, (2) seizure recurrence associated with stroke recurrence beyond the 7-day period and (3) unprovoked seizure (US) >7 days.

Results 104 patients (mean age 65 years/55% female) with AS after ischaemic stroke were identified (mean follow-up 6.17 years). Comparison of the group of patients with AS and those without seizures showed that patients with AS had significantly less large-vessel and small-vessel disease but more cardioembolisms (p<0.05) and a higher proportion of TCOR (p<0.01), multiple territory infarcts (p=0.007) and haemorrhagic transformations (p<0.01). Using Kaplan–Meier statistics, the risk of acute clustering of seizures ≤7 days was 22%, with a statistical trend for TCOR as a predictive factor (p=0.06). The risk of seizure recurrence associated with worsening/recurrence of stroke beyond 7 days was 13.5% at 2 years, 16.4% at 4 years and 18% at 8 years. Presence of >2 cardiovascular risk factors (p<0.05) and status epilepticus (P<0.05) are predictive risk factors on Cox regression model. The risk of US was 19% at 2 years, 25% at 4 years and 28% at 8 years with epileptiform EEG as a predictive factor (p<0.05).

Conclusions Seizure recurrence following AS after ischaemic stroke may appear as acute clustering. Afterwards, seizures may occur as often with a recurrent stroke as without one within 4.2 years. We recommend the use of antiepileptic agents for up to 4 years if the underlying stroke aetiology cannot be fully treated.


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  • Contributors TL and HL contributed to the planning, conduct and reporting of the work in this paper. YS was the leader in the maintenance of stroke registry. VM and KSW contributed towards the clinical care of the patients and overlooked the conception, design and acquisition of data/analysis of the study.

  • Funding Kwok Tak Seng Centre for Stroke Research and Intervention.

  • Competing interests None declared.

  • Ethics approval Clinical Research & Ethics Committee (CREC) of New Territories East Cluster (NTEC), Hong Kong SAR China.

  • Provenance and peer review Not commissioned; externally peer reviewed.