{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:55:47Z","timestamp":1792619747127,"version":"4.5.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background and objectives<\/jats:title><jats:p>Post-stroke epilepsy (PSE) is a significant concern in the elderly population, with stroke being a leading cause of epilepsy in this demographic. Several factors have shown consistent associations with the risk of developing PSE, including cortical lesions, initial stroke severity, younger age, and the occurrence of early seizures. The primary objectives of this study were two-fold: (1) to determine the incidence of PSE and (2) to identify the risk factors associated with PSE in a prospective cohort of post-stroke patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective single-hospital study was conducted, involving patients diagnosed with acute ischemic and hemorrhagic stroke. The patients were followed up for 2 years (or until death) from the time of admission. Data about seizure occurrence and recurrent stroke were collected. Kaplan\u2013Meyer curves were used for the assessment of PSE incidence and mortality. Possible predictors of PSE and mortality were selected from between-group analysis and tested in multivariable regressions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our study enrolled a total of 424 patients diagnosed with acute stroke. Among them, 97 cases (23%) experienced early post-stroke seizures, and 28 patients (6.6%) developed PSE. The cumulative risks of developing PSE were found to be 15.4% after hemorrhagic stroke and 8.7% after ischemic stroke. In multivariable fine and gray regression with competitive risk of death, significant predictors for developing PSE in the ischemic cohort were watershed infarction (HR 6.01, 95% CI 2.29\u201315.77, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) and low Barthel index at discharge (HR 0.98, CI 0.96\u20130.99, <jats:italic>p<\/jats:italic> = 0.04). Furthermore, patients who eventually developed PSE showed slower recovery and presented a worse neurologic status at the time of discharge. The in-hospital dynamics of the National Institutes of Health Stroke Scale (NIHSS) were significantly worse in the PSE group compared to the non-PSE group (<jats:italic>p<\/jats:italic> = 0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>A higher proportion of cases experienced early seizures compared to what has been commonly reported in similar studies. Watershed stroke and low Barthel index at discharge were both identified as independent risk factors of PSE in ischemic strokes, which sheds light on the underlying mechanisms that may predispose individuals to post-stroke epilepsy after experiencing an ischemic stroke.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1273270","type":"journal-article","created":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T17:54:42Z","timestamp":1701539682000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":29,"title":["Post-stroke seizures, epilepsy, and mortality in a prospective hospital-based study"],"prefix":"10.3389","volume":"14","author":[{"given":"Sofia","family":"Freiman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Allen","family":"Hauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flora","family":"Rider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Yaroslavskaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Sazina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Vladimirova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Kaimovsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Shpak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Gulyaeva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alla","family":"Guekht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1111\/ene.13813","article-title":"Stroke-related epilepsy","volume":"26","author":"Feyissa","year":"2019","journal-title":"Eur J Neurol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1111\/j.1528-1157.1996.tb00017.x","article-title":"Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study","volume":"37","author":"Forsgren","year":"1996","journal-title":"Epilepsia."},{"key":"B3","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1111\/j.1528-1157.1993.tb02586.x","article-title":"Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935\u20131984","volume":"34","author":"Hauser","year":"1993","journal-title":"Epilepsia."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1001\/archneur.57.11.1617","article-title":"Seizures after stroke","volume":"57","author":"Bladin","year":"2000","journal-title":"Arch Neurol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1161\/STROKEAHA.111.000220","article-title":"Incidence and associations of poststroke epilepsy the prospective South London stroke register","volume":"44","author":"Graham","year":"2013","journal-title":"Stroke."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0055498","article-title":"Post-stroke epilepsy in young adults: a long-term follow-up study","volume":"8","author":"Arntz","year":"2013","journal-title":"PLoS ONE."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2364","DOI":"10.1007\/s00415-015-7850-0","article-title":"Does treatment with t-PA increase the risk of developing epilepsy after stroke?","volume":"262","author":"Keller","year":"2015","journal-title":"J Neurol Springer Berlin Heidelberg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.09.008","article-title":"Seizures following ischemic stroke: frequency of occurrence and impact on outcome in a long-term population-based study","volume":"25","author":"Bryndziar","year":"2016","journal-title":"J Stroke Cerebrovasc Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1161\/STROKEAHA.111.000232","article-title":"Incidence and predictors of late seizures in intracerebral hemorrhages","volume":"44","author":"Rossi","year":"2013","journal-title":"Stroke."},{"key":"B10","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1016\/j.eplepsyres.2014.02.020","article-title":"Immediate, early and late seizures after primary intracerebral hemorrhage","volume":"108","author":"Qian","year":"2014","journal-title":"Epilepsy Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1212\/WNL.0000000000004009","article-title":"Poststroke epilepsy in long-term survivors of primary intracerebral hemorrhage","volume":"88","author":"Lahti","year":"2017","journal-title":"Neurology."},{"key":"B12","doi-asserted-by":"publisher","first-page":"106586","DOI":"10.1016\/j.eplepsyres.2021.106586","article-title":"Increased mortality after post-stroke epilepsy following primary intracerebral hemorrhage","volume":"172","author":"Lahti","year":"2021","journal-title":"Epilepsy Res."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1806","DOI":"10.1016\/j.eplepsyres.2014.09.030","article-title":"Risk factors for post-stroke seizures: a systematic review and meta-analysis","volume":"108","author":"Zhang","year":"2014","journal-title":"Epilepsy Res."},{"key":"B14","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1111\/epi.13671","article-title":"Instruction manual for the ILAE 2017 operational classification of seizure types","volume":"58","author":"Fisher","year":"2017","journal-title":"Epilepsia."},{"key":"B15","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1007\/s10309-018-0218-6","article-title":"ILAE classification of the epilepsies: position paper of the ILAE commission for classification and terminology","volume":"31","author":"Scheffer","year":"2017","journal-title":"Zeitschrift fur Epileptol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1111\/j.1528-1167.2011.03341.x","article-title":"Impaired consciousness in epilepsy investigated by a prospective responsiveness in epilepsy scale (RES)","volume":"53","author":"Yang","year":"2012","journal-title":"Epilepsia."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1111\/epi.13121","article-title":"A definition and classification of status epilepticus - report of the ILAE task force on classification of status epilepticus","volume":"56","author":"Trinka","year":"2015","journal-title":"Epilepsia."},{"key":"B18","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1111\/epi.12550","article-title":"ILAE official report: a practical clinical definition of epilepsy","volume":"55","author":"Fisher","year":"2014","journal-title":"Epilepsia."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1111\/j.1528-1167.2008.01945.x","article-title":"Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure","volume":"50","author":"Hesdorffer","year":"2009","journal-title":"Epilepsia."},{"key":"B20","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1161\/01.STR.0000202590.75972.39","article-title":"Internal and cortical border-zone infarction: Clinical and diffusion-weighted imaging features","volume":"37","author":"Seok","year":"2006","journal-title":"Stroke."},{"key":"B21","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1161\/01.STR.0000155727.82242.e1","article-title":"The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies","volume":"36","author":"Momjian-Mayor","year":"2005","journal-title":"Stroke."},{"key":"B22","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.seizure.2013.01.014","article-title":"Seizures after cerebrovascular events: risk factors and clinical features","volume":"22","author":"Conrad","year":"2013","journal-title":"Seizure."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1136\/bmj.315.7122.1582","article-title":"Epileptic seizures after a first stroke: the Oxfordshire community stroke project","volume":"315","author":"Burn","year":"1997","journal-title":"BMJ Br Med J."},{"key":"B24","doi-asserted-by":"publisher","first-page":"117138","DOI":"10.1016\/j.jns.2020.117138","article-title":"Prevalence and predictors of post-stroke epilepsy among Ghanaian stroke survivors","volume":"418","author":"Sarfo","year":"2020","journal-title":"J Neurol Sci."},{"key":"B25","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/S1474-4422(17)30404-0","article-title":"Prediction of late seizures after ischaemic stroke with a novel prognostic model (the SeLECT score): a multivariable prediction model development and validation study","volume":"17","author":"Galovic","year":"2018","journal-title":"Lancet Neurol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2309","DOI":"10.1161\/STROKEAHA.115.010115","article-title":"Poststroke epilepsy is associated with a high mortality after a stroke at young age: follow-up of transient ischemic attack and stroke patients and unelucidated risk factor evaluation study","volume":"46","author":"Arntz","year":"2015","journal-title":"Stroke."},{"key":"B27","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.jstrokecerebrovasdis.2005.07.001","article-title":"Poststroke epilepsy in the Copenhagen stroke study: incidence and predictors","volume":"14","author":"Kammersgaard","year":"2005","journal-title":"J Stroke Cerebrovasc Dis."},{"key":"B28","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1111\/j.1528-1157.1992.tb01698.x","article-title":"Epilepsy after stroke","volume":"33","author":"Kotila","year":"1992","journal-title":"Epilepsia."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1212\/WNL.0b013e3182364878","article-title":"Incidence and predictors of acute symptomatic seizures after stroke","volume":"77","author":"Beghi","year":"2011","journal-title":"Neurology."},{"key":"B30","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.clineuro.2010.01.004","article-title":"Acute ischemic stroke treatment and the occurrence of seizures","volume":"112","author":"De Reuck","year":"2010","journal-title":"Clin Neurol Neurosurg."},{"key":"B31","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1016\/j.neuroscience.2010.02.047","article-title":"Tissue plasminogen activator and urokinase plasminogen activator in human epileptogenic pathologies","volume":"167","author":"Iyer","year":"2010","journal-title":"Neuroscience."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.yebeh.2019.106476","article-title":"Incidence of early poststroke seizures during reperfusion therapies in patients with acute ischemic stroke: An observational prospective study (TESI study: \u201cTrombolisi\/Trombectomia e crisi Epilettiche precoci nello Stroke Ischemico\u201d)","volume":"104","author":"Belcastro","year":"2020","journal-title":"Epilepsy Behav."},{"key":"B33","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1002\/ana.26212","article-title":"Seizures after ischemic stroke: a matched multicenter study","volume":"90","author":"Ferreira-Atuesta","year":"2021","journal-title":"Ann Neurol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.yebeh.2017.12.037","article-title":"Health-related quality of life in patients with poststroke epilepsy","volume":"80","author":"Winter","year":"2018","journal-title":"Epilepsy Behav."},{"key":"B35","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1159\/000484477","article-title":"A methodological perspective on the longitudinal cognitive change after stroke","volume":"44","author":"Lim","year":"2018","journal-title":"Dement Geriatr Cogn Disord."},{"key":"B36","doi-asserted-by":"publisher","first-page":"312","DOI":"10.3340\/jkns.2012.52.4.312","article-title":"Seizures after spontaneous intracerebral hemorrha","volume":"52","author":"Woo","year":"2012","journal-title":"J Korean Neurosurg Soc."},{"key":"B37","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1111\/ane.13403","article-title":"Poststroke epilepsy incidence, risk factors and treatment: German claims analysis","volume":"143","author":"Hardtstock","year":"2021","journal-title":"Acta Neurol Scand."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.2147\/CLEP.S168169","article-title":"Development and validation of risk score to estimate 1-year late poststroke epilepsy risk in ischemic stroke patients","volume":"10","author":"Chi","year":"2018","journal-title":"Clin Epidemiol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s41983-018-0045-8","article-title":"Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in egyptian patients with watershed zone infarction","volume":"55","author":"Elsadek","year":"2019","journal-title":"Egypt J Neurol Psychiatry Neurosurg."},{"key":"B40","doi-asserted-by":"publisher","first-page":"2179","DOI":"10.1161\/01.STR.25.11.2179","article-title":"Frequency and pathogenesis of hemodynamic stroke","volume":"25","author":"Bladin","year":"1994","journal-title":"Stroke."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1001\/archneurol.2010.263","article-title":"Watershed infarctions are more prone than other cortical infarcts to cause early-onset seizures","volume":"67","author":"Denier","year":"2010","journal-title":"Arch Neurol."},{"key":"B42","first-page":"767","article-title":"Epileptic crisis during and after cerebrovascular diseases. A clinical analysis of 78 cases","volume":"12","author":"Milandre","year":"1992","journal-title":"Rev Neurol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1111\/ane.13174","article-title":"Post-stroke epilepsy in an ischemic stroke cohort\u2014Incidence and diagnosis","volume":"141","author":"Hassani","year":"2020","journal-title":"Acta Neurol Scand."},{"key":"B44","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1159\/000348704","article-title":"Complications of acute stroke and the occurrence of early seizures","volume":"35","author":"Pezzini","year":"2013","journal-title":"Cerebrovasc Dis."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1111\/j.1468-1331.2012.03782.x","article-title":"Early seizures in first-ever acute stroke patients in India: incidence, predictive factors and impact on early outcome","volume":"19","author":"Goswami","year":"2012","journal-title":"Eur J Neurol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1","DOI":"10.11604\/pamj.2015.20.136.5925","article-title":"Early seizures in acute stroke","volume":"20","author":"Mohamed","year":"2015","journal-title":"Pan Afr Med J."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jns.2021.117535","article-title":"Frequency and factors associated with post-stroke seizures in a large multicenter study in West Africa","volume":"427","author":"Sarfo","year":"2021","journal-title":"J Neurol Sci."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1007\/s00415-017-8586-9","article-title":"Post-stroke seizures are clinically underestimated","volume":"264","author":"Bentes","year":"2017","journal-title":"J Neurol r."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.1007\/s00415-010-5520-9","article-title":"Prospective evaluation of a post-stroke epilepsy risk scale","volume":"257","author":"Strzelczyk","year":"2010","journal-title":"J Neurol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"1971","DOI":"10.1161\/STROKEAHA.114.004686","article-title":"The CAVE score for predicting late seizures after intracerebral hemorrhage","volume":"45","author":"Haapaniemi","year":"2014","journal-title":"Stroke."},{"key":"B51","doi-asserted-by":"publisher","first-page":"2229","DOI":"10.1212\/WNL.0000000000001643","article-title":"Epilepsy after aneurysmal subarachnoid hemorrhage: a population-based, long-term follow-up study","volume":"84","author":"Huttunen","year":"2015","journal-title":"Neurology."},{"key":"B52","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.jstrokecerebrovasdis.2011.01.006","article-title":"Clinical features of late-onset poststroke seizures","volume":"21","author":"Okuda","year":"2012","journal-title":"J Stroke Cerebrovasc Dis."},{"key":"B53","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1159\/000382078","article-title":"Are early seizures predictive of epilepsy after a stroke? Results of a population-based study","volume":"45","author":"Serafini","year":"2015","journal-title":"Neuroepidemiology."},{"key":"B54","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.seizure.2019.07.010","article-title":"Efficacy of Statin therapy in post-stroke seizure prophylaxis: clues from an observational study of routine secondary prevention treatment","volume":"71","author":"Li","year":"2019","journal-title":"Seizure."},{"key":"B55","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-020-60628-9","article-title":"National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases","volume":"10","author":"Z\u00f6llner","year":"2020","journal-title":"Sci Rep."},{"key":"B56","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1111\/epi.13062","article-title":"In-hospital costs in patients with seizures and epilepsy after stroke","volume":"56","author":"Guekht","year":"2015","journal-title":"Epilepsia."},{"key":"B57","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/B978-0-444-52899-5.00016-2","article-title":"Seizures after stroke","volume":"108","author":"Guekht","year":"2012","journal-title":"Handb Clin Neurol."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1273270\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T17:54:45Z","timestamp":1701539685000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1273270\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,1]]},"references-count":57,"alternative-id":["10.3389\/fneur.2023.1273270"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2023.1273270","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,1]]},"article-number":"1273270"}}