New model predicts late seizures after ischemic stroke

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Takeaway

  • The 5-factor SeLECT score performs well at predicting development of seizures in the 5 years after ischemic stroke.

Why this matters

  • Development of late poststroke seizures is variable.
  • A reliable predictor would help inform counseling and management, and select patients for prevention trials.

Key results

  • Incidence of late seizures was 4% at 1 year and 8% at 5 years.
  • Final SeLECT model contained 5 variables (severity of stroke, large-artery atherosclerotic etiology, early seizures, cortical involvement, territory of middle cerebral artery involvement), with scores from 0 to 9.
  • Patients with SeLECT score of 0 had a 0.7% risk for late seizures within 1 year and 1.3% risk within 5 years.
  • Patients with score of 9 had corresponding risks for 63% and 83%.
  • Overall model concordance was high in validation cohorts (c-statistic, 0.77).

Study design

  • A model development and validation study among 1200 Swiss patients with ischemic stroke, with external validation among 1169 patients from 3 independent international cohorts in Austria, Germany, Italy.
  • Main outcome: discrimination of patients who had seizure onset late (>7 days) after ischemic stroke.
  • Funding: None.

Limitations

  • Patients with severe stroke often died before long-term follow-up.
  • Follow-up duration varied.
  • Imaging modalities differed across cohorts.