Authors: Djingri Labodi LOMPO, Alassane ZOUNGRANA, Fabienne KERE, Aimé SAWADOGO, Christian NAPON, Athanase MILLOGO.
Introduction: The aim of this study was to assess the incidence and identify the main risk factors associated with early poststroke epileptic seizures.
Patients and Methods: This was a descriptive and analytical cross-sectional study, with prospective, multicentre hospital collection, that involved patients hospitalised for stroke in the university hospitals of Ouagadougou, Burkina Faso, from 1st /03/ 2021 to 30/09/2021. Consenting patients, aged ≤ 18 years, hospitalised for a first episode of stroke confirmed by CT and/ or brain MRI, less than 72 hours old, were included in the study. The diagnosis of early post-stroke epileptic seizure (EPSES) was based on direct observation of at least one epileptic seizure episode symptomatic of an acute cerebral insult directly and exclusively related to the acute stroke, occurring during the 7 days following the stroke. Socio-demographic, clinical (stroke and any epileptic seizures), paraclinical (brain CT, EEG and biological) variables were studied. A bivariate and then multivariate analysis using a logistic regression model with the calculation of ROs and 95% confidence intervals (95% CI) was used to identify the risk factors for the occurrence of EPSES (p≤ 0.05).
Results: A total of 347 patients were hospitalised for stroke, with an average age of 59.6 years, including 232 cases of cerebral infarction (66.9%), 113 cases of intracerebral haemorrhage (32.6%) and 2 cases of cerebral venous thrombosis (0.5%). The predominant location of stroke lesions was supratentorial cortical with or without subcortical extension in 139 patients (40.1%), with large strokes accounting for 8.2% of cases.
The frequency of EPSES was 10.1% (35 patients), with an average onset time of 26.1 hours. Seizures were more frequently repetitive (82.8%) and focal (48.6%). Phenobarbital and carbamazepine, used in 19 patients (54.3%) and 11 patients (31.4%) respectively, were the most frequently prescribed anti-epileptic drugs. After multivariate analysis with logistic regression, the cortical lobar location of the stroke (OR 5.29; 95% CI [1.56-20], p=0.008) and the large size of the stroke (OR 2.22; 95% CI [1.43-6.56], p=0.001) were identified as independent risk factors for the occurrence of EPSES.
Conclusion: In our context, EPSESs are fairly frequent, occurring predominantly within 24 hours of the stroke and favoured by the cortical location and large size of the stroke. Improved stroke management would help to reduce this frequency.
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