Epilepsia Partialis Continua After an Anterior Circulation Ischaemic Stroke

Background and purpose: Although cerebrovascular disorders are the main cause of epilepsia partialis continua (EPC) in adulthood, the frequency of EPC after stroke is unknown. The aim was to prospectively ascertain its frequency 1 year after an ischaemic stroke. Methods: This was a prospective study of consecutive acute anterior circulation ischaemic stroke patients, previously independent, with an admission National Institutes of Health Stroke Scale score ≥4, an acute ischaemic lesion on imaging and no previous epileptic seizures. During admission patients received standardized diagnostic and medical care and were submitted to a neurophysiological evaluation protocol. One year after stroke, patients were re-evaluated by an epilepsy expert neurologist and performed a video-electroencephalogram with electromyography co-registration whenever myoclonus was observed during neurological examination for jerk-locked back averaging analysis (JLBA). EPC was defined as continuously repeated fragments of epileptic seizures, with preserved consciousness, lasting at least 1 h, and representing locally restricted epileptic activity. Results: In all, 151 acute anterior circulation stroke patients were consecutively included and prospectively evaluated, but 23 died in the first year. One year after stroke, from 127 patients alive, 117 (92.1%) underwent clinical and neurophysiological evaluation. In two (1.7%) patients, EPC diagnosis was made both by clinical and electroencephalographic criteria, namely JLBA. Both patients had a history of remote symptomatic seizures and one of them acute symptomatic seizures and non-convulsive status epilepticus criteria during the first 7 days after stroke. Conclusions: Despite its low frequency, the high stroke incidence makes post-stroke EPC relevant. This study draws attention to this recognizable condition with therapeutic and eventually prognostic implications.

Keywords

HSJ MED Humans Aged Aged, 80 and over Male Female Brain Ischemia / complications* Middle Aged Brain Ischemia / diagnostic imaging Brain Ischemia / epidemiology Cerebral Arteries / diagnostic imaging Cerebrovascular Circulation Electroencephalography Electromyography Epilepsia Partialis Continua / diagnostic imaging Epilepsia Partialis Continua / epidemiology Epilepsia Partialis Continua / etiology* Incidence Neurologic Examination Neuroimaging Prospective Studies Prognosis Stroke / complications* Stroke / epidemiology Stroke / diagnostic imaging