A Study to evaluate clinical profile of seizures in cases of Stroke.

Stroke is defined as sudden onset of neurological dysfunction secondary to vascular etiology either ischemic or hemorrhagic. Stroke is associated with a significant mortality and high morbidity. It is the third leading cause of death in developed countries and in developing countries it is fast catching up as one of the leading causes of death. Seizures is a common neurological disorder. John Hughling Jackson first recognized the relation between stroke and seizures more than a century ago stroke has been considered one of the most common causes of epilepsy in adult population especially in people above 60 years age. Post stroke seizures significantly increase morbidity in stroke patients. Seizures occur in about 8- 10% of stroke patients. About 10% of patients with post stroke seizures present with status epilepticus. Seizures after stroke are common but development of epilepsy is rare. Post stroke seizures are divided into early (onset within two weeks) and late (onset after two weeks). Early onset seizures are considered to be secondary to local metabolic and toxic factors, while late onset seizures occurs secondary to gliotic area following stroke. Chances of epilepsy are more after late onset seizures. Incidence of post stroke seizures is more in hemorrhagic stroke than in ischemic stroke. Cortical lesions are more likely to cause seizures than sub cortical and larger lesions are more likely to cause seizures. Venous infarcts cause seizures more frequently than arterial infarcts. Post stroke seizures adversely affect the outcome of stroke. Post Stroke seizures usually require short term antiepileptic drug treatment and in most instances are well controlled by monotherapy. Still there is no consensus regarding prophylactic antiepileptic therapy, but American Heart Association recommends prophylactic antiepileptic drug treatment in cases of lobar hematoma and sub arachnoid hemorrhage. Most of the studies of post stroke seizures are retrospective analysis of case records. There have been very few prospective studies to define the incidence of seizures in stroke and their clinical profile. The present study was done to evaluate the clinical profile on post stroke seizures prospectively in south Indian Population. CONCLUSION : This prospective study has evaluated the clinical profile of seizures in cases of acute stroke. Single seizure, shorter duration, in this study did not show any adverse outcome however the patients who had early onset recurrent seizures focal becoming generalized, lasting for prolonged duration were associated with poor outcome. If the study is extended to a larger population and longer duration with appropriate monitoring of stroke and seizure cascades will be of immense help to the acute stroke patients with seizures