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Pre-stroke seizures: A nationwide register-based investigation

Journal article
Authors Johan Zelano
David Larsson
E. Kumlien
S. Asberg
Published in Seizure-European Journal of Epilepsy
Volume 49
Pages 25-29
ISSN 1059-1311
Publication year 2017
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Pages 25-29
Language en
Links doi.org/10.1016/j.seizure.2017.05.0...
Keywords (limit 8): seizure, Stroke, Epilepsy, Prevention, Epidemiology, late-onset seizures, poststroke epilepsy, subsequent stroke, Neurosciences & Neurology
Subject categories Neurology

Abstract

Purpose: The relationship between cerebroyascular disease and seizures is clearly illustrated by poststroke epilepsy. Seizures can also be the first manifestation of cerebrovascular disease and case control studies have demonstrated that seizures carry an increased risk of subsequent stroke. Thus, seizures could serve as a marker for vascular risk that merits intervention, but more data is needed before proper trials can be conducted. The occurrence of pre-stroke seizures has not been assessed on a national scale. We asked what proportion of strokes in middle-aged and elderly patients was preceded by seizures. Methods: All patients over 60 years of age with first-ever stroke in 2005-2010 (n = 92,596) were identified in the Swedish stroke register (Riksstroke) and cross-sectional data on a history of a first seizure or epilepsy diagnosis in the ten years preceding stroke were collected from national patient registers with mandatory reporting. Results: 1372 patients (1.48%) had a first seizure or epilepsy diagnosis registered less than ten years prior to the index stroke. The mean latency between seizure and stroke was 1474 days (SD 1029 days). Conclusions: Seizures or epilepsy preceded 1.48% of strokes in patients > 60 years of age. Based on recent national incidence figures, 5-20% of incident cases of seizures or epilepsy after 60 years of age could herald stroke, depending on age group. These proportions are of a magnitude that merit further study on how to reduce the risk of stroke in patients with late-onset seizures or epilepsy. (C) 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

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