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Original Contribution
October 2010

Watershed Infarctions Are More Prone Than Other Cortical Infarcts to Cause Early-Onset Seizures

Author Affiliations

Author Affiliations: Departments of Neurology (Drs Denier, Masnou, Mapoure, Guedj, Théaudin, Fagniez, Join-Lambert, Lozeron, and Adams) and Neuroradiology (Drs Souillard-Scemama and Ducreux), Centre Hospitalo–Universitaire de Bicêtre, Assistance Publique–Hôpitaux de Paris; and Unité “Epidémiologie, Démographie et Sciences Sociales,” IFR69, INED, INSERM U822 (Dr Ducot); Université Paris 11 (Drs Souillard-Scemama, Fagniez, Join-Lambert, Ducreux, and Adams); and INSERM U788 (Drs Denier, Ducreux, and Adams), le Kremlin-Bicêtre, France.

Arch Neurol. 2010;67(10):1219-1223. doi:10.1001/archneurol.2010.263

Background  Early-onset seizures(ESs) have been reported in 2% to 6% of strokes. Most previous studies have been retrospective and did not systematically perform cerebral magnetic resonance imaging (MRI).

Objective  To determine the prevalence and determinants of ESs in a prospective cohort.

Design  Prospective cohort study.

Setting  Stroke unit in an academic hospital.

Patients  Six hundred sixty-one consecutive individuals admitted to our stroke unit during an 18-month period for suspected stroke.

Main Outcome Measures  Initial investigations systematically included cerebral MRI. Among patients with MRI-confirmed cerebral infarction, individuals with ES, defined as occurring within 14 days of stroke, were identified.

Results  Three hundred twenty-eight patients had MRI-confirmed cerebral infarcts and 178 had cortical involvement. The ESs, all initially partial seizures, occurred in 14 patients (4.3%) and at stroke onset in 5 patients. The ESs occurred exclusively in patients with cortical involvement (P <.001). With infarcts involving the cerebral cortex, there was a higher risk of ESs in watershed infarctions than in territorial strokes (6 of 26 [23.1%] vs 8 of 152 [5.3%], P = .007). Logistic regression analysis showed an almost 4-fold increased risk of ES in patients with watershed infarctions compared with other cortical infarcts (odds ratio, 4.7; 95% confidence interval, 1.5- 15.4; P = .01). Age, sex, diabetes mellitus, hypertension, smoking, National Institutes of Health Stroke Scale score, and cardioembolic origin were not significant risk factors for ES.

Conclusions  The cortical hemispheric location of ischemic strokes is associated with a higher risk of ES. Among these patients, the watershed mechanism is a strong and independent determinant of stroke-related ES.