Journal article
Association of the Timing and Type of Acute Symptomatic Seizures With Poststroke Epilepsy and Mortality
Stroke (1970), Vol.56(7), pp.1748-1757
07/2025
DOI: 10.1161/STROKEAHA.124.050045
PMCID: PMC12180697
PMID: 40270248
Abstract
BACKGROUND:Acute symptomatic seizures (ASyS) increase the risk of epilepsy and mortality after a stroke. The impact of the timing and type of ASyS remains unclear.METHODS:This multicenter cohort study included data from 9 centers between 2002 and 2018, with a final analysis in February 2024. The study included 4552 adults (2005 female; median age, 73 years) with ischemic stroke and no seizure history. Seizures were classified using International League Against Epilepsy definitions. We examined ASyS occurring within 7 days after stroke. The main outcomes were all-cause mortality and epilepsy. Validation of the updated SeLECT score (SeLECT-ASyS) was performed in 3 independent cohorts (Switzerland, Argentina, and Japan) collected between 2012 and 2024, including 74 adults with ASyS.RESULTS:The 10-year risk of poststroke epilepsy ranged from 41% to 94%, and mortality from 36% to 100%, depending on ASyS type and timing. ASyS on stroke onset day had a higher epilepsy risk (adjusted hazard ratio [aHR], 2.3 [95% CI, 1.3-4.0]; P=0.003) compared with later ASyS. Status epilepticus had the highest epilepsy risk (aHR, 9.6 [95% CI, 3.5-26.7]; P<0.001), followed by focal to bilateral tonic-clonic seizures (aHR, 3.4 [95% CI, 1.9-6.3]; P<0.001). Mortality was higher in those with ASyS presenting as focal to bilateral tonic-clonic seizures on day 0 (aHR, 2.8 [95% CI, 1.4-5.6]; P=0.004) and status epilepticus (aHR, 14.2 [95% CI, 3.5-58.8]; P<0.001). The updated SeLECT-ASyS model, available as an application, outperformed a previous model in the derivation cohort (concordance statistics, 0.68 versus 0.58; P=0.02) and in the validation cohort (0.70 versus 0.50; P=0.18).CONCLUSIONS:ASyS timing and type significantly affect epilepsy and mortality risk after stroke, improving epilepsy prediction and guiding patient counseling.
Details
- Title: Subtitle
- Association of the Timing and Type of Acute Symptomatic Seizures With Poststroke Epilepsy and Mortality
- Creators
- Kai Michael Schubert - University of ZurichDominik Zieglgansberger - Kantonsspital St. GallenGiulio Bicciato - University of ZurichLaura Abraira - Universitat Autònoma de BarcelonaEstevo Santamarina - Universitat Autònoma de BarcelonaJose Alvarez-Sabin - Vall d'Hebron Hospital UniversitariCarolina Ferreira-Atuesta - Epilepsy SocietyMira Katan - University Hospital of BaselLucia Sinka - Schulthess-KlinikRobert Terziev - University of ZurichNico Deligas - Kantonsspital St. GallenBarbara Erdelyi-Canavese - Kantonsspital St. GallenAnsgar Felbecker - Kantonsspital St. GallenPhilip Siebel - Kantonsspital St. GallenMichael Winklehner - Johannes Kepler University of LinzTim J von Oertzen - Johannes Kepler University of LinzJudith N. Wagner - Johannes Kepler University of LinzGian Luigi Gigli - University of UdineAnnacarmen Nilo - University of UdineFrancesco Janes - University of UdineGiovanni Merlino - University of UdineMariarosaria Valente - University of UdineMaria Paula Zafra-Sierra - Fundación Santa Fe de BogotáLuis Carlos Mayor-Romero - Universidad de Los AndesJulian Conrad - University of MünsterStefan Evers - University of MünsterMatias Alet - Fundación para la Lucha contra las Enfermedades Neurológicas de la InfanciaKazuki Fukuma - National Cerebral and Cardiovascular CenterMasafumi Ihara - National Cerebral and Cardiovascular CenterBenjamin Landau - Saarland UniversityPiergiorgio Lochner - Saarland UniversityFrauke Roell - Saarland UniversityFrancesco Brigo - Krankenhaus MeranCarla Bentes - Hospital de Santa MariaAna Rita Peralta - Hospital de Santa MariaTeresa Pinho e Melo - Hospital de Santa MariaMark R. Keezer - Stichting Epilepsie Instellingen NederlandJohn S. Duncan - Epilepsy SocietyJosemir W. Sander - Stichting Epilepsie Instellingen NederlandBarbara Tettenborn - Kantonsspital St. GallenMatthias J. Koepp - Epilepsy SocietyMarian Galovic - University of Zurich
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.56(7), pp.1748-1757
- DOI
- 10.1161/STROKEAHA.124.050045
- PMID
- 40270248
- PMCID
- PMC12180697
- NLM abbreviation
- Stroke
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 10
- Grant note
- UK Department of Health; National Institutes of Health Research (NIHR) Fundacio La Marato de TV3 (Spain) Swiss National Science Foundation; Swiss National Science Foundation (SNSF) Christelijke Vereniging voor de Verpleging van Lijders aan Epilepsie (the Netherlands) Marvin Weil Epilepsy Research Fund
- Language
- English
- Date published
- 07/2025
- Academic Unit
- Neurology
- Record Identifier
- 9985016524102771
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