Risk Factors for Nonconvulsive Status Epilepticus after Stroke

Abstract

Background: Status epilepticus (SE) sometimes occurs after stroke. SE is classified as convulsive SE (CSE) and nonconvulsive SE (NCSE). Clinical characteristics, outcomes, mortality, and recurrences of post-stroke NCSE are yet to be clarified. Methods: We retrospectively identified post-stroke SE patients between April 2010 and September 2015, with follow-ups continued until March 2016. We compared baseline clinical characteristics (age, sex, past history of epilepsy, early seizure, stroke type, and localization) between the CSE and NCSE groups. We determined the Glasgow Outcome Scale (GOS) at discharge, along with the mortality and seizure recurrence rates for the two groups. Results: We identified 300 consecutive post-stroke seizure patients admitted to our department. A total of 50 post-stroke SE patients (33 men; mean age, 71.6 ± 14.2 years; 38 CSE; 12 NCSE; 20 ischemic strokes; 23 intracerebral hemorrhages; 7 subarachnoid hemorrhages) were included. Multivariable analysis showed that cardioembolic stroke and frontal lesion were significant risk factors of NCSE after stroke. GOS (Scale 1/2/3/4/5) results at patient discharge showed there was no significant difference between the groups (CSE; 8/26.3/18.4/26.3/21%, NCSE; 0/25/33/25/17%). Follow-up in 31 patients (21 CSE, 10 NCSE, median 815 days, interquartile range 538–1,327 days), revealed that seizure recurred in 15 CSE patients (71%) and in 4 NCSE patients (40%). During the follow-up, 3 CSE patients (14%) and 2 NCSE patients (20%) died. Seizure recurrence and mortality were not significantly different between the 2 groups. Conclusion: Cardioembolic stroke and frontal lesion were significant risk factors of NCSE after stroke.