Post-Stroke Seizure

Kathryn Epperson, Charmaine Jenkins, Johnie Hodge, Kathleen Cao, Michael Kozik, Hamilton Peters, James Selph, Souvik Sen, Renu Pokharna

The incidence of post-stroke seizure is estimated around 8.9% with higher frequency in those with hemorrhagic or cortical-related strokes. These seizures can be immediate or removed from the original stroke by a substantial length of time, and the patient may go on to develop epilepsy or experience only a single, isolated seizure event. Such seizure activity can impede recovery and increase long-term disability in post-stroke patients. Therefore, it is of the utmost importance to determine the most effective therapies to reduce the likelihood and frequency of their occurrence. Currently, there is no antiepileptic drug (AED) specifically marketed for post-stroke seizures and epilepsy, as no trials have been performed in this specific population. Consequently, choice of AED for post-stroke seizure and epilepsy fits with the guidelines for seizures and epilepsy in general. There are at least 26 medications used to control seizure activity, each with varying effect on different seizure types. Our study will broadly involve collecting data from the medical records of patients presenting either with an acute stroke or newly identified seizure to PRISMA Health Richland. Patients will be identified using Emergency Department data, the “Get with the Guidelines” (GWTG) database, the “Brain Attack” (BAT) database, and further searches of the electronic medical record with the assistance of the Clinical Informatics department. We propose employing two strategies to identify patients experiencing post-stroke seizures. The first is a retrospective cohort study and will first set out to determine the number of patients who have experienced post-stroke seizures during the initial stroke admission to PRISMA Health Richland from 2012 to the present. This information will be used to determine the proportion of stroke patients in total and per year in the acute setting. Our second study will take a form similar to a case series and will involve first identifying patients presenting to the Neurology service with new-onset seizures. Patients whose histories include a previous stroke will then be selected based on the following criteria for inclusion in the study. Logistic regression models will be built with whether a seizure occurred during the stroke admission (yes/no) as the outcome variable for the retrospective cohort data. Candidate risk factors will be entered into the model, which will be selected on clinical grounds as well as a Bayesian information criterion. Statistics for the case series are anticipated to be almost entirely descriptive, and will focus on the variables of acute and chronic management.

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