Investigation of poststroke epilepsy (INPOSE) study: a multicenter prospective study for prediction of poststroke epilep
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Investigation of poststroke epilepsy (INPOSE) study: a multicenter prospective study for prediction of poststroke epilepsy Shuichi Yamada1 · Ichiro Nakagawa1 · Kentaro Tamura1 · Fumihiko Nishimura1 · Yasushi Motoyama1 · Young‑Soo Park1 · Hiroyuki Nakase1 Received: 6 April 2020 / Revised: 3 June 2020 / Accepted: 5 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background and purpose Poststroke epilepsy is a common problem in clinical practice. This study aimed to determine the predictors of poststroke epilepsy and to identify the risk factors. Methods A total of 436 patients were enrolled for this study. Baseline characteristics were recorded. Patients were followed up for 3 years. According to the occurrence of late seizures (i.e., seizure occurring 8 days or later after the stroke), the patients were separated into two groups: a seizure group and a seizure-free group. Baseline characteristics were compared between the groups. Univariate and multivariate Cox regression analysis was used to identify the risk factors for occurrence of poststroke epilepsy. The study was registered in the University Hospital Medical Information Network Center Clinical Trials Registry (registration number UMIN000009659, date 28/December/2012). Results Among the 436 patients, 26 developed late seizures—an incidence rate of 5.96%. In univariate analysis, female, subarachnoid hemorrhage, hemorrhagic lesion, lesion affecting the cortex, lesion affecting the frontal lobe, and absence of comorbidities were the significant risk factors for occurrence of epilepsy. In multivariate analysis, the independent predictors of poststroke epilepsy were hemorrhagic lesion (hazard ratio (HR) = 3.03) and lesion location in the cortex (HR = 4.64). The incidence of poststroke epilepsy in patients with both two risk factors was 15.4%. Conclusions Poststroke epilepsy occurs in almost 6% of patients within 3 years after stroke onset. Hemorrhagic stroke and subcortical lesion appear to be significantly associated with likelihood of developing epilepsy. Thus, prophylactic administration of antiepileptic drugs could be useful for stroke patients with these two risk factors. Keywords Stroke · Epilepsy · Risk factor · Seizure
Introduction Poststroke epilepsy is a common problem that often hinders the reintegration of patients into society after an acute stroke. Better understanding of this condition will help to improve management, especially with regard to the use of antiepileptic drugs. Seizure occurring after stroke are of two types: early seizure (occurring within 1 week of stroke Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-09982-2) contains supplementary material, which is available to authorized users. * Shuichi Yamada syamada@naramed‑u.ac.jp 1
Department of Neurosurgery, Nara Medical University, 840, Shijo‑cho, Kashihara, Nara, Japan
onset) and late seizure (occurring after this period) [1–4]. These two types complet
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