@article {Leung86, author = {Thomas Leung and Howan Leung and Yannie O Y Soo and Vincent C T Mok and K S Wong}, title = {The prognosis of acute symptomatic seizures after ischaemic stroke}, volume = {88}, number = {1}, pages = {86--94}, year = {2017}, doi = {10.1136/jnnp-2015-311849}, publisher = {BMJ Publishing Group Ltd}, abstract = {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{\textendash}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.}, issn = {0022-3050}, URL = {https://jnnp.bmj.com/content/88/1/86}, eprint = {https://jnnp.bmj.com/content/88/1/86.full.pdf}, journal = {Journal of Neurology, Neurosurgery \& Psychiatry} }