Vol. 4, Issue 1 (2019)
A study of predictors of onset of seizure and predominant seizure type in post stroke patients
Author(s): Dr. Bharat Gramani, Dr. Shubham Dubey, Dr. TN Dubey, Dr. Shishirendu Parihar
Abstract: Introduction: Previous studies have reported that post stroke seizure (PSS) accounts for 4% to 10% cases. Many of these data were based on retrospective studies often without CT confirmation of lesion. Often included patients were those of arterio-venous malformations, brainstem strokes, subarachnoid hemorrhages or patient with a previous history of seizure or epilepsy. In present study we evaluated the predictors of onset of seizure and predominant seizure type in patients of PSS. Materials and Methods: Fifty patients of PSS were studied in Hamidia Hospital from December 2017 to April 2018. CT scan and EEG were performed in all the patients. CT finding were categorized as Infarction and hemorrhage. Infarcts were sub classified as cortial and subcortical (Small as <5cm and Large >5cm). Hemorrhage was also noted for their location and volume (Small as 0-29 ml and Large as 30 ml or more). EEG findings are categorized as Normal; Diffuse slowing, Focal Slowing and Epileptiform discharges. Results: PSS was more common in the age group of >60 years (64%)]. Majority of the patients had hemorrhagic stroke (62%). Early onset seizure occurred in 72% and late onset occurred in 28% of patients. Focal seizures were seen in 54%, generalized seizure in 24% and 10% patients developed status epilepticus. In Early onset seizure 44% were focal, 30.6% were generalized and all 5 cases of status epilepticus were early onset. Among late onset 71.4% were focal. Cortical location (68.4%) was commonly associated with PSS. Lobar hemorrhages were the most common cause of PSS (77.4%) and among them deep hemorrhage (78%) was most common. Among the ischemic stroke patients, large lesion was majorly associated (63.2%) whereas among hemorrhagic stroke patients, large size of lesion was associated with 83.8% PSS patients. Mortality was reported only in patients with early onset seizure. Conclusion: We conclude that PSS is more common in hemorrhagic stroke. Early onset of post stroke is most common. Corticle localization is seen in ischemic stroke. Lobar localization is associated with increased risk of PSS in hemorrhagic stroke. Size of lesions is an important risk factor for PSS. Among the subtype focal seizure is most common. Mortality was mainly seen in early onset of seizure patients and patients with status epilepticus.
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