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Background: The risk of epileptic seizures after ischemic
stroke depends on various risk factors and ranges from 3%
to 6% in most studies. Whether lesion size is a risk factor
remains unclear to date as studies addressing this topic are
heterogeneous and mainly rely on CT-based volume
measurements.
Methods: We studied all patients with new ischemic strokes
included over a period of one year in the SERES (Stroke
and Epilepsy Registry of Eastern Switzerland) data base.
Patients were followed prospectively and checked 2 years
after stroke for new onset of epileptic seizures. Based on
MRI (DWI, FLAIR and T2 sequences) or CT images
achieved after the acute phase of stroke, lesion volumes
were measured with ImageJ®. Statistical analyses were
performed using a Wilcoxon-Mann-Whitney test.
Results: 334 patients were included in the study. 269
patients (80.5%) were studied with MRI, the remainder
with CT scans. After two years of follow-up, 19 patients
(5.6%) had suffered from at least one epileptic seizure.
Median lesion volumes differed significantly between
patients with epileptic seizures (16.36ml [IQR 4.02-
216.73]) and without seizures (3.62ml [IQR 0.86-21.34];
p=0.0053). Univariate analysis of other risk factors revealed
a significant link between developing epileptic seizures and
higher baseline NIH-SS, diabetes and carotid
macroangiopathy.
Conclusion: Modern imaging modalities such as MRI
show that lesion volume of ischemic strokes might be a risk
factor for developing post-stroke epileptic seizures.
Whether this variable is an independent risk factor needs to
be tested by multivariate analysis in a larger cohort.