To determine the effect of reperfusion therapies on the occurrence of early post stroke seizures (PSS) in patients with acute ischemic stroke (AIS).

Reperfusion therapies are paramount to the treatment of stroke in the acute phase. Their effect on incidence of early seizures after an AIS remains unclear.

The stroke database at Hamad Medical Corporation was used to identify all patients who received reperfusion therapies for AIS from 2016 to 2019. They were matched with patients of similar diagnosis, gender, age and stroke severity as measured by NIHSS who did not receive such treatment. The rates of early PSS were then measured for each group.

508 patients received reperfusion therapies (342 thrombolysis only, 70 thrombectomy only, and 96 received both), compared to 501 matched patients receiving standard stroke unit care. Patients who received reperfusion therapies were similar to their matched controls for mean admission NIHSS score (9.87 versus 9.79; p=0.831), mean age (53.3 versus 53.2 years; p=0.849), and gender distribution (85.0% versus 86.0% men; p=0.655). The group receiving reperfusion therapies was found to have increased stroke cortical involvement (62% versus 49.3%, p<0.001) and hemorrhagic transformation rates (33.5% versus 18.6%, p<0.001) compared to the control group. The rate of early PSS was significantly lower in patients who received reperfusion therapies compared to those who did not (3.1% versus 5.8%, respectively; p=0.042). When we excluded seizures occurring at stroke onset prior to any potential treatment implementation, the difference in early PSS rates between the two groups was no longer significant (2.6% versus 3.9%, respectively; p=0.251). There was no significant difference in early PSS rate based on type of reperfusion therapy either (3.2% with thrombolysis, 2.9% with thrombectomy, and 3.1% for the combined treatment, p=0.309). 

Treatment of AIS with either thrombectomy, thrombolysis or both does not increase the risk of early PSS.