Age- and sex- related characteristics in people with post-stroke epilepsy: initial presentation, stroke features, and mortality

BACKGROUND: Post-stroke epilepsy (PSE) affects 2-14% of ischaemic stroke survivors and is associated with increased mortality and poorer functional recovery. Although stroke characteristics differ by age and sex, demographic differences within PSE cohorts remain understudied. AIM: To assess age- and sex-related differences in seizure presentation, stroke characteristics, and mortality within a well-characterised PSE cohort. METHODS: We included consecutive people with ischaemic stroke at the University Hospital Innsbruck (2014-2017 and 2020-2025) who developed PSE (median follow-up 40 months). Data on PSE onset, stroke severity, aetiology, SeLECT score, and mortality were extracted from electronic medical records and analysed using regression models. RESULTS: Among 84 individuals (38 women; median age 72.4 years), the latency to the first unprovoked seizure (median 266 days) and seizure type did not differ by age or sex. Women tended to present with more severe strokes, and cardioembolism was their most common aetiology (47%); however, sex differences in stroke severity and aetiology were not statistically significant. Overall mortality was 33% (22% in men vs 47% in women; p = 0.02). Increased age (HR 1.09, p < 0.001), greater discharge stroke severity (p = 0.005), and poorer pre-stroke function (p = 0.004) independently predicted mortality and accounted for the higher crude mortality in women. Status epilepticus and focal to bilateral tonic-clonic seizures as initial seizure types were associated with particularly high mortality (71% and 39%; adjusted HR 2.98, p = 0.02). CONCLUSION: Cardioembolism was the leading stroke aetiology in women with PSE. Mortality was driven by age, stroke severity, and initial seizure type rather than sex.