Incidence of Epileptic Seizures during and after Stroke in a Ten-Year Survey at Department of Neurology, Sarajevo University Hospital Center

Association between epilepsy and stroke has been known since 1864. The pathophysiological basis of epileptic seizures during and after stroke are molecular changes that occur in ischemia as primary events, and in hemorrhage as secondary events. The aim of the study was to determine the incidence of epileptic seizures during and after stroke, recorded over a 10-year period at the Department of Neurology, Sarajevo University Clinical Center. The study covered the period from January 1, 1989 till December 31, 1998. During the period, 7001 patients were treated at the Department. Cerebral thrombosis predominated (53.6%), whereas there were only 17.25% of patients with cerebral embolism, 21.96% with intracerebral hemorrhage, and 7.17% with subarachnoid hemorrhage. The incidence of symptomatic epileptic seizures for total patient sample according to years ranged from 0.75% to 6.67%. According to type of insult, the incidence of symptomatic epileptic seizures was 1.0%-3.37% for cerebral thrombosis, 1.22%-6.67% for cerebral embolism, 0.65%4.05% for intracerebral hemorrhage, and 1.34%-4.34% for subarachnoid hemorrhage. Associated epileptic seizures, i.e. the seizures accompanying the onset of stroke, were not included in the study. Results of the study showed that there were 75 patients with symptomtic epileptic seizures (47 with late seizures and 28 with early seizures, or 1.998% of total patient sample) during the 10-year period of observation. There were 36 cases of cerebral embolism (23 and 13 in the group of late and early seizures, respectively; 2.980%), 30 cases of intracerebral hemorrhage (23 and seven with late and early seizures, respectively; 1.951%), and seven cases of subarachnoid hemorrhage (four with late and three with early seizures; 1.394%). According to stroke types and subtypes, hemorrhagic stroke was found to be a more common etiologic factor for the occurrence of early and late symptomatic epileptic seizures, whereas cerebral embolism in ischemic stroke was a more common cause of symptomatic epileptic seizures than cerebral thrombosis. During the study period, the years 1993, 1994 and 1995 were characterized by a small number of patients with symptomatic early and late epileptic seizures (9 in total). The incidence of early and late epileptic seizures in the sample of stroke patients during the study period ranged from 1.394% to 2.980%.