Stroke treatments can save lives and spare brain tissue when delivered in the first few hours after a stroke. They may also increase the risk of seizures for years, according to a study presented at the 2017 American Epilepsy Society (AES) annual meeting in Washington, DC.

About 10% of stroke patients will develop symptomatic epilepsy and more than 30% of cases of epilepsy in the elderly occur following a stroke, according to previous research. The new study found that patients who received reperfusion therapy have about three times the risk of post-stroke seizures as stroke patients who do not receive acute therapies.

Stroke. (Source: Creative Commons)

The researchers conducted a retrospective, multicenter cohort of patients with anterior circulation ischemic stroke treated at the Royal Melbourne Hospital in Australia and the Nanjing General Hospital in China between 2008 and 2015. Of the 1943 total patients, 363 received intravenous tissue plasminogen activator (IV-tPA) alone, 205 received IV-tPA with intra-arterial therapy (IAT), 93 received just IAT and 1375 received no reperfusion therapy.

In the two years following their strokes, 2% of patients who received standard stroke unit care without reperfusion therapy experienced seizures compared to 5.8% of those who received IV-tPA alone, 8.3% of those who had both IV-tPA and IAT, and 12.9% of those who had only IAT. Seizure development was significantly associated with IV-tpA alone (odds ratio [OR] 2.5; 95% CI, 1.3-5.0; P =.009), IV-tPA and IAT (OR 3.2; 95% CI, 1.4-7.4; P =.006), and IAT alone (OR 3.8; 95% CI, 1.5-9.6; P =.005). Hemorrhagic transformation increased the risk of seizures in patients who received IAT with or without IV-tPA.

The researchers recommended that “patients undergoing IV-tPA and/or IAT for acute ischaemic stroke may benefit from longer stroke follow-up, particularly IAT treated patients who had haemorrhagic transformation.”