To characterize the clinical features associated with acute symptomatic seizures in acute ischemic stroke and identify risk factors for seizure recurrence.

Patients with acute symptomatic seizures in the setting of acute stroke have increased risk for post-stroke epilepsy, but most do not experience seizure recurrence. Identification of patients at higher risk for seizure recurrence could guide decision-making regarding need for long-term therapy which has potential detrimental effects on neurological recovery. 

We performed a retrospective review of patients admitted to our institution between 2019-2023 with acute ischemic stroke and acute symptomatic seizures, excluding patients with epilepsy and other pathologies associated with seizures. We registered data on seizure and stroke features and acute seizure risk factors during the hospitalization and post-hospital follow-up. Acute seizure risk factors included hyperglycemia (glucose > 300 mg/dL) on admission, benzodiazepine withdrawal, and electrolyte disturbances. Exploratory univariate analyses were performed to assess associations for seizure recurrence.

Acute symptomatic seizures tend to occur in the hyperacute period in acute ischemic stroke and often precede stroke symptoms. Acute seizure risk factors were associated with increased risk for late seizure recurrence. Further data collection will be conducted to elucidate risk for individual clinical features and relate these to other findings that convey risk for epilepsy.