Investigate risk factors for post-stroke epilepsy (PSE) and their association with clinical factors among adults with acute stroke at the University Teaching Hospital (UTH) in Lusaka, Zambia.

The burden of and risk factors for PSE among patients presenting with acute stroke in resource-limited settings is unknown, especially in sub-Saharan Africa. 

A prospective cohort of adults (>18 years old) admitted to the neurology service at UTH with suspected or confirmed stroke was conducted between November 2021 and August 2022. PSE was defined as any self- or caregiver-reported seizure occurring within one year of post-discharge follow-up.  Acute seizures were those occurring at stroke onset or during inpatient stroke hospitalization.  Participant demographics, stroke type and clinical characteristics were compared between those with and without PSE using t-tests, chi-square analyses, and Wilcoxon rank-sum tests as appropriate.

Of 316 participants who survived acute hospitalization, 13 (4%) PSE, including 10% (n=4) of the 42 participants who had acute seizures and 3% (n=9) of the 274 participants without acute seizures. Amongst those with acute seizures and PSE, 75% were people with HIV compared to only 20% of participants who experienced acute seizures but did not develop PSE (p=0.04).  Amongst those without acute seizures, 33% (n=3) of those with PSE had a history of a prior stroke compared to only 12% (n=32) of those without PSE (p=0.07).  Development of PSE did not differ by demographic characteristics, stroke type (ischemic versus hemorrhagic; large vessel occlusion vs other), or non-HIV comorbid conditions.

Adults with HIV and stroke who experience acute seizures were significantly more likely to develop PSE than their HIV-uninfected counterparts, suggesting this group should be closely monitored and managed with long-term antiseizure medications.  Future work should explore mechanisms for this increased risk of PSE among people with HIV and acute seizures.