Early and late epileptic crisis following cerebral hemisphere ischemia

INTRODUCTION: There is no agreement as to the frequency and characteristics of epileptic seizures (ES) associated with cerebrovascular disease (CVD). OBJECTIVE: To analyze the presence of early (Se) and late (SI) ES, factors related to these, prognosis and conversion to epilepsy. PATIENTS AND METHODS: We made a retrospective study of 386 patients with cerebral hemisphere ischemia (100 TIA and 286 infarcts). Follow-up was 29.69 +/- 13.92 months. Two groups were defined: a) Patients without ES, and b) patients with ES. Those occurring within 15 days of the episode of ischemia were considered to be Se and the others Sl. We studied the prognosis (modified Rankin scale on discharge from hospital) and mortality. RESULTS: Twenty three patients (6%) had crises (18 Se and 5 Sl). The commonest type was simple partial motor crises (13 or 56.5%) followed by generalized tonic-clonic crises (9 or 39.1%) which predominated in the Se group. There were 6 solitary crises (Se) and 17 (73.9%) recurrences (66.6% of the Se and 100% of the Sl) (p = 0.049). There was an association between the presence of a family history of epilepsy (p < 0.001) and increased risk factors for epilepsy and CVD, particularly previous ictus and cardiopathy respectively (p = 0.034). No patient with TIA or lacunar infarct had ES. Extensive infarcts showed and increased tendency to the associated with hemorrhagic transformation, involvement of the cortex (p < 0.001) and cardioembolic incidents (p = 0.025). They had a worse prognosis, led to more disability (p < 0.001) and earlier mortality (38.4%) (during the first three months) (p = 0.015). These factors were associated (p < 0.001). CONCLUSIONS: Postischemic cerebral seizures are frequent and have a high recurrence rate, especially in patients with extensive infarcts involving the cortex and these of embolic origin. The prognosis is worse when crises occur early.