HOUSTON—Younger age and greater stroke volume are risk factors for the development of poststroke epilepsy, according to research presented at the 70th Annual Meeting of the American Epilepsy Society.
Beate Diehl, MD, PhD, neurologist and clinical neurophysiologist at University College London, and colleagues examined information from the Predicting Language Outcome and Recovery After Stroke (PLORAS) database to ascertain the frequency of poststroke epilepsy and compare lesion characteristics between people with and without poststroke epilepsy. The database includes T1-weighted whole brain MRIs acquired with a 3-T scanner.
Beate Diehl, MD, PhD
The investigators identified 369 patients with left-hemisphere strokes, and 42 of them (11.4%) had poststroke epilepsy. Of 81 patients with right-hemisphere strokes, nine (11.1%) had poststroke epilepsy. Gender, handedness, and stroke etiology were similar between patients with and without poststroke epilepsy.
Patients with poststroke epilepsy were significantly younger than those without poststroke epilepsy, however (44 vs 56). In addition, patients with poststroke epilepsy had significantly larger lesions than patients without poststroke epilepsy (148 cm3 vs 73 cm3). Large lesions are more likely to damage deep white matter, said Dr. Diehl.
The most consistent lesion sites among all patients with poststroke epilepsy included the basal ganglia (ie, globus pallidus and caudate nucleus) and most nuclei of the thalamus (ie, anterior and ventral nuclei and posterior regions, including pulvinar). Damage to these regions occurred in 27 (64%) of patients with left-hemisphere stroke and poststroke epilepsy. Furthermore, 55 (17%) patients with left-hemisphere stroke without poststroke epilepsy also had damage in the same regions. Damage to these regions thus was associated with poststroke epilepsy in 27 of 82 (33%) patients.
“Many physicians treating stroke patients do not realize that falls, episodes of confusion, and loss of consciousness may be signs of poststroke epilepsy,” said Dr. Diehl. “Poststroke epileptic seizures can negatively affect stroke recovery and rehabilitation.”
—Erik Greb