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From the Departments of Neurology (Drs. So and Whisnant) and Health Sciences Research (Drs. O'Brien and Whisnant), Mayo Clinic and Mayo Medical School, Rochester MN; University of Texas Health Sciences Center (Dr. Annegers), Houston, TX; and G.H. Sergievsky Center (Dr. Hauser), New York, NY. Supported by Mayo Foundation for Medical Education and Research and National Institutes of Health P-50 NS-16308.
Presented in part at the Scientific Program of the 46th Annual Meeting of the American Academy of Neurology, Washington, DC, May, 1994.
Received March 7 1995. Accepted in final form June 24, 1995.
Address correspondence and reprint requests to Dr. Elson L. So, Department of Neurology, Mayo Clinic (W-8A), 200 First St. S. W, Rochestei, MN 55905.
We performed the first population-based study that determined the magnitude of the risk and identified the factors predictive of developing seizure disorders after cerebral infarction. Five hundred thirty-five consecutive persons without prior unprovoked seizures were followed from their first cerebral infarctions until death or migration out of Rochester, Minnesota. Thirty-three patients (6%) developed early seizures (within 1 week), 78% of which occurred within the first 24 hours after infarction. Using multivariate analysis, the only factor predictive of early seizure occurrence was anterior hemisphere location of infarct (odds ratio 4.0, 95% CI 1.2 to 13.7). Twenty-seven patients developed an initial late seizure (past 1 week), whereas 18 developed epilepsy (recurrent late seizures). Compared with the population in the community, the risk during the first year was 23 times higher for initial late seizures and 17 times higher for epilepsy. The cumulative probability of developing initial late seizures was 3.0% by 1 year, 4.7% by 2 years, 7.4% by 5 years, and 8.9% by 10 years. Independent predictive factors on multivariate analysis for initial late seizures were early seizure occurrence (hazard ratio of 7.8 [95% CI 2.8 to 21.7]) and stroke recurrence (3.1 [1.2 to 8.3]). Both early seizure occurrence (16.4 [5.5 to 49.2]) and stroke recurrence (3.5 [1.2 to 10.5]) independently predicted the development of epilepsy as well. We also found that early seizure occurrence predisposed those with initial late seizures to develop epilepsy.
NEUROLOGY 1996; 46 350-355
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