The primary objective was to assess the occurrence of early seizures after acute ischemic stroke. The secondary objective was to determine the predictors of early seizures after acute ischemic stroke and to create an early seizure prediction score.

Stroke is the most common cause of epilepsy in the adult population. Post stroke seizures (PSS) are classified into early seizures (ES) and late seizures (LS). ES can significantly affect the clinical outcome and occurrence of LS.

We analyzed data from a prospective cohort of acute ischemic stroke patients between June 2018-May 2020 in a neurology unit at a tertiary hospital. We screened all acute stroke patients and included consecutive patients older than 18 years of age, presenting with acute, first-ever neuroimaging-confirmed ischemic stroke. We excluded patients with a previous stroke, transient ischemic attacks, hemorrhagic stroke, cerebral venous thrombosis, prior history of seizures or any other epileptogenic comorbidity. ES were classified as spontaneous seizures occurring within one week of the stroke. The main outcome assessed was the occurrence of ES. The secondary outcome was to determine predictors of ES and to create an ES prediction score.

We screened 432 patients, of which 291 were enrolled. ES occurred in 37 patients (12.7%). Cortical location (OR-4.2), large artery disease subtype (OR-2.9), mRS at presentation (OR-1.4), use of anti-coagulants (OR-2.6) and hypertension (OR-0.3) were significantly associated with the occurrence of ES. Patients with ES had a statistically significant worse clinical outcome at three months follow-up (p-0.0072).

We could formulate an ES prediction tool using the following components: a) Cortical location b) Large-vessel stroke c) mRS at admission d) anti-coagulant use e) history of hypertension. This tool might help in treating patients at high risk for ES with prophylactic ASD, thereby preventing seizures and their complications.