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Population-Based Assessment of the Long-Term Risk of Seizures in Survivors of Stroke.

TitlePopulation-Based Assessment of the Long-Term Risk of Seizures in Survivors of Stroke.
Publication TypeJournal Article
Year of Publication2018
AuthorsMerkler AE, Gialdini G, Lerario MP, Parikh NS, Morris NA, Kummer B, Dunn L, Reznik ME, Murthy SB, Navi BB, Grinspan ZM, Iadecola C, Kamel H
JournalStroke
Volume49
Issue6
Pagination1319-1324
Date Published2018 06
ISSN1524-4628
KeywordsAdult, Aged, Aged, 80 and over, Cerebral Hemorrhage, Female, Hospitalization, Humans, Incidence, Male, Middle Aged, Patient Discharge, Retrospective Studies, Risk Factors, Seizures, Stroke, Survivors, Time Factors, United States
Abstract

BACKGROUND AND PURPOSE: We sought to determine the long-term risk of seizures after stroke according to age, sex, race, and stroke subtype.

METHODS: We performed a retrospective cohort study using administrative claims from 2 complementary patient data sets. First, we analyzed data from all emergency department visits and hospitalizations in California, Florida, and New York from 2005 to 2013. Second, we evaluated inpatient and outpatient claims from a nationally representative 5% random sample of Medicare beneficiaries. Our cohort consisted of all adults at the time of acute stroke hospitalization without a prior history of seizures. Our outcome was seizure occurring after hospital discharge for stroke. Poisson regression and demographic data were used to calculate age-, sex-, and race-standardized incidence rate ratios (IRR).

RESULTS: Among 777 276 patients in the multistate cohort, the annual incidence of seizures was 1.68% (95% confidence interval [CI], 1.67%-1.70%) after stroke versus 0.15% (95% CI, 0.15%-0.15%) among the general population (IRR, 7.3; 95% CI, 7.3-7.4). By 8 years, the cumulative rate of any emergency department visit or hospitalization for seizure was 9.27% (95% CI, 9.16%-9.38%) after stroke versus 1.21% (95% CI, 1.21%-1.22%) in the general population. Stroke was more strongly associated with a subsequent seizure among patients <65 years of age (IRR, 12.0; 95% CI, 11.9-12.2) than in patients ≥65 years of age (IRR, 5.5; 95% CI, 5.4-5.5) and in the multistate analysis, the association between stroke and seizure was stronger among nonwhite patients (IRR, 11.0; 95% CI, 10.8-11.2) than among white patients (IRR, 7.3; 95% CI, 7.2-7.4). Risks were especially elevated after intracerebral hemorrhage (IRR, 13.3; 95% CI, 13.0-13.6) and subarachnoid hemorrhage (IRR, 13.2; 95% CI, 12.8-13.7). Our study of Medicare beneficiaries confirmed these findings.

CONCLUSIONS: Almost 10% of patients with stroke will develop seizures within a decade. Hemorrhagic stroke, nonwhite race, and younger age seem to confer the greatest risk of developing seizures.

DOI10.1161/STROKEAHA.117.020178
Alternate JournalStroke
PubMed ID29695463
PubMed Central IDPMC6093303
Grant ListR01 NS037853 / NS / NINDS NIH HHS / United States
R01 NS100447 / NS / NINDS NIH HHS / United States
R01 NS073666 / NS / NINDS NIH HHS / United States
T32 NS007153 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States
R01 NS034179 / NS / NINDS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States
U01 NS095869 / NS / NINDS NIH HHS / United States
KL2 TR002385 / TR / NCATS NIH HHS / United States
R37 NS089323 / NS / NINDS NIH HHS / United States
K23 NS082367 / NS / NINDS NIH HHS / United States

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