Abstracts

Rationale: Limited information is available about the impact of seizures on stroke outcome. Our aims were to determine whether the occurrence of seizures is an independent predictor of higher morbidity and mortality and to compare health care utilization. Methods: This multicenter cohort study included consecutive patients with an acute ischemic stroke, between July 2003 and March 2005, in the Registry of the Canadian Stroke Network (RCSN). The RCSN is the largest clinical database of patients with acute stroke patients seen at selected acute care hospitals in Canada. We compared clinical characteristics and outcomes among patients experiencing stroke without and with seizures (seizures as part of the clinical presentation and seizures occurring after a stroke). Main outcome measures included: case-fatality, disability at discharge (modified-Rankin scale=mRS), length-of-stay, and resources utilization. A logistic regression analysis was used to determine whether the presence of seizures in stroke was associated with poor outcomes. Results: Among 5,027 patients included in the study, seizures occurred as part of stroke presentation in 122 (2.4%). 138 (2.7%) patients experienced seizures during hospitalization. Seizures at stroke presentation were associated with higher mortality at 30-day (24.6% vs. 17.2%, p=0.03) and 1-year post-stroke (39.3% vs. 28%, p<0.05), but did not influence in-hospital deaths (p=0.2). Patients presenting with seizures had longer hospitalization (22.6 vs. 16.3 days, p<0.05) and more disabling strokes (3.2 vs. 4.4 mRS; p<0.05). Multivariate analysis revealed that age (<60), stroke severity, weakness, and non-lacunar infarcts were associated with seizures at the stroke presentation; while stroke severity, neglect, pneumonia, ICH, and seizures as stroke presentation, were associated to occurrence of seizures after stroke. Conclusions: Patients with seizures after stroke had more disability, higher mortality, and longer hospital stay. This information may help implement strategies to optimize the discharge planning and improve the quality of stroke care.