Post-stroke epilepsy in Saudi Arabia - frequency, management and outcomes at a comprehensive stroke center in Riyadh, Kingdom of Saudi Arabia

BACKGROUND: Approximately 5% to 7% of patients with stroke develop post-stroke epilepsy (PSE). There is limited published literature about frequency, characteristics and outcomes of post-stroke epilepsy in Saudi population. OBJECTIVES: We determined the frequency, management and outcomes of post-stroke epilepsy in a Saudi cohort. METHODS: After IRB approval, a retrospective chart-review was performed on patients admitted with stroke at King Abdulaziz Medical City, MNGHA, Riyadh between January 2016 and December 2020. PSE was defined as one or more seizures after the 7th day of incident stroke. The diagnosis was clinical, EEG was not required to make the diagnosis of PSE. Data was collected about demographic features, stroke characteristics, epilepsy management and outcomes. Data was analyzed using RStudio (R version 4.3.1.). Consecutive, nonrandom sampling technique was used and all patients were included from the study period. RESULTS: A total of 2985 patients were included, of whom 2596 (87.0%) had ischemic stroke, 389 (13.0%) had hemorrhagic stroke. PSE occurred in 164 (5.49%) patients. The median age was 66.0 years (IQR:55.5-76.5), 102 (62.2%) were men, and 157 (95.7%) were Saudis. In ischemic group, 129 (4.97%) had PSE, whereas 35 (8.99%) in hemorrhagic group (p = 0.001). The commonest type of seizures was generalized in 96 (58.5%), focal in 45 (27.4%), unclassified in 23 (14.0%). Twenty-six (16%) patients had status epilepticus. Epileptiform abnormalities were seen in 16 (9.8%) on electroencephalogram. Treatment was started in 151 (93.8%) after first seizure, levetiracetam was commonest 1st antiseizure medication (ASM) used in 133 (82.6%). Side effects were reported in 11 (6.9%) patients; behavioral changes in 9 (5.5%), irritability in 6 (3.7%) patients. Nineteen (11.8%) patients needed 2nd ASM, 10 (6.1%) needed 3rd ASM. Median (IQR) follow-up was 26.0 (13.0-48.0) months. At last follow up, 120 (87%) were seizure free. CONCLUSIONS: Post-stroke epilepsy was common in our cohort. The patients with hemorrhagic stroke were more likely to have post-stroke epilepsy compared to ischemic stroke. Generalized seizures were the commonest type of seizure. Most patients had good control at last follow up requiring only monotherapy.