The risk of new-onset epilepsy and refractory epilepsy in older adult stroke survivors
Document Type
Article
Publication Date
8-6-2019
Journal
Neurology
Volume
93
Issue
6
URL with Digital Object Identifier
https://doi.org/10.1212/WNL.0000000000007895
Abstract
Objective Our study objectives were to identify factors associated with new-onset epilepsy and refractory epilepsy among older adult stroke survivors and to evaluate the receipt of diagnostic care and mortality for participants who developed epilepsy.
Methods We conducted a population-based, retrospective cohort study using linked, administrative health care databases. The Ontario Stroke Registry was used to identify patients 67 years and older who were hospitalized for a stroke at a designated stroke center in Ontario, Canada, between April 1, 2003, and March 31, 2009, and were previously free of epilepsy. Multivariable Fine–Gray hazard models were used to examine risk factors of epilepsy and refractory epilepsy, accounting for the competing risk of death.
Results Among 19,138 older adults hospitalized for a stroke, 210 (1.1%) developed epilepsy and 27 (12.9%) became refractory to antiepileptic drugs. Within 1 year of epilepsy diagnosis, 24 (11.4%) patients were assessed with EEG and 19 (9.0%) with MRI. In multivariable analysis, younger age and thrombolysis receipt significantly increased epilepsy risk. Lesser stroke severity and anticoagulant medication receipt also significantly increased epilepsy risk; however, these effects decreased over time. Younger age and female sex were the only risk factors of refractory epilepsy. In the 5 years following epilepsy diagnosis, 97 (46.2%) participants died of any cause.
Conclusions Older adult stroke survivors are less likely to develop epilepsy and pharmacologically refractory epilepsy. An estimated 86.6% of deaths among older adult stroke survivors with new-onset epilepsy are attributed to causes other than stroke or epilepsy.
Notes
Project summary:
https://ir.lib.uwo.ca/neuruprojectsummaries/1/