Epileptic Seizure: Red Flag for Stroke

Seizures After Age 60 Mean Threefold Higher Stroke Risk

From the WebMD Archives

April 9, 2004 -- An unexplained epileptic seizure is a red flag: After age 60, a seizure could mean a great risk for stroke, new research shows.

A first-time seizure after age 60 means an almost threefold higher risk of stroke, reports lead researcher Paul Cleary, MD, with Scotland's Gartnaval General Hospital in Glasgow. His study appears in this week's issue of The Lancet.

This is the largest study thus far looking at this link between stroke and epilepsy seizure, writes Cathie L. M. Sudlow, MD, in a commentary published in The Lancet. Sudlow is a neuroscience professor at the University of Edinburgh.

Because this study shows an increased risk for stroke in this population, it seems reasonable to look for and manage other risks factors for strokes, she writes. Health care providers might also consider treatments to prevent stroke.

Pinpointing the Pattern

Other studies have suggested that epileptic seizures in some people are the first manifestation of otherwise concealed stroke -- damage to blood vessels in the brain, writes Cleary.

Brain scans of stroke patients have shown previously unsuspected stroke-related lesions on the brain, he writes. Therefore, finding a risk factor for future strokes could be very important in targeting preventive strategies.

Another study found that epilepsy was more common among stroke patients. "These findings suggested that epilepsy may be a harbinger of future stroke," Clearly writes.

To better pinpoint this pattern, Cleary's research group identified 4,709 people who had seizures either at age 60 or after 60, as well as a similar-sized group without seizures for comparison. Those who had any history of stroke, brain injury, drug or alcohol abuse, or dementia were not included.

He then looked for those who had suffered a stroke later on and found that 10% of patients in the seizure group had strokes later, compared with 4% in the control group -- a significant difference, he reports.

"Our findings show that the onset of seizures in late life is associated with a striking increase in the risk of stroke," writes Cleary. He calls for further research looking at specific treatments to prevent strokes after epileptic seizures.

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SOURCES: Cleary, P. The Lancet, April 10, 2004; vol 363: pp 1184-1186. Sudlow, C. The Lancet, April 10, 2004; vol 363: pp 1175-1176.
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