Seizure recurrence after first epileptic episode in ischemic stroke: Risk factors and their association with cognition and mood

Abstract

BACKGROUND

Ischemic stroke (IS) survivors face an elevated risk of epileptic seizures, and recurrent seizures following the first episode often signal worsening functional outcomes.

AIM

To investigate risk factors associated with seizure recurrence after a first episode in patients with IS and explore their associations with cognitive function, anxiety, and depression.

METHODS

A total of 100 patients with IS admitted to Shaanxi Provincial People’s Hospital between January 2017 and January 2024 were enrolled in this study. After a 1-5-year follow-up, patients were categorized into recurrence (n = 43) and non-recurrence (n = 57) groups. Their medical records were collected and analyzed using univariate and multivariate analyses to determine potential predictors of seizure recurrence. Variables with statistical significance in the univariate analysis were incorporated into a binary logistic regression model for multivariate analysis. The risk model’s predictive performance was evaluated using the receiver operating characteristic curve. How independent risk factors, identified in multivariate analysis, related to cognitive [Montreal Cognitive Assessment (MoCA)] and emotional [Self-Rating Anxiety Scale (SAS)/Self-Rating Depression Scale (SDS)] outcomes, were assessed.

RESULTS

Recurrent seizures were significantly associated with age, stroke severity (National Institutes of Health Stroke Scale), late-onset seizures, electroencephalogram abnormalities, cortical involvement, hemorrhagic infarction, and extensive cerebral infarctions, with late-onset seizures, cortical involvement, and hemorrhagic infarction serving as independent predictors. The risk model revealed an area under the curve of 0.732, with 88.37% specificity and 42.11% sensitivity. These three were also correlated with lower MoCA scores and higher SAS and SDS scores.

CONCLUSION

In patients with IS, recurrent seizures after the first episode can be independently predicted by late-onset seizures, cortical involvement, and hemorrhagic cerebral infarction-factors also correlating with cognitive impairment and emotional distress. These findings underscore the need for close clinical monitoring and targeted interventions (e.g., cognitive rehabilitation and psychological support) to mitigate seizure recurrence in high-risk individuals.

Keywords: Ischemic stroke; First seizure; Recurrence; Risk factors; Cognitive function; Anxiety; Depression

Core Tip: In a cohort of 100 patients with ischemic stroke, we identified delayed seizure onset, cortical lesions, and hemorrhagic infarction as key predictors of recurrent seizures following a first episode. These risk factors also showed strong associations with cognitive impairment and emotional distress.