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| CORRESPONDENCE |
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| Year : 2018 | Volume
: 66
| Issue : 6 | Page : 1854-1855 |
Early post-stroke seizures: An unresolved question
Ravinder-Jeet Singh
Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| Date of Web Publication | 28-Nov-2018 |
Correspondence Address:
Dr. Ravinder-Jeet Singh
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Room 1207, 1th Floor, Foothills Medical Centre, 1403 29th Street NW, Calgary
Canada
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.246292
How to cite this article:
Singh RJ. Early post-stroke seizures: An unresolved question. Neurol India 2018;66:1854-5 |
We read with great interest the recent article by Shehta et al., on early seizures after first-ever stroke in Egyptian stroke patients.[1] The article implicates the prognostic role of early seizures in the first-ever stroke patients. Most findings are in line with the previously published literature[2] and confirm them in the Egyptian cohort. Despite numerous studies available in literature on the topic, it is still unclear how best to predict and manage seizure after stroke. In relation to the published article, we would like to seek some clarifications from the authors and highlight some important methodological issues.
First, an interesting correlation has been found in the previous studies between early seizures and watershed infarcts instead of the territorial infarcts.[3] This was neither reported nor discussed in the article. What percentage of patients had a cardioembolic source among patients having seizure versus those who did not have a seizure? This information is particularly important as patients with cardioembolic stroke more often have larger strokes, which are frequently cortex based, often with hemorrhagic transformation and generally have a higher initial stroke severity, and also tends to have the worse functional outcome.[4] This might be the single denominator that explains most associations seen in the study between seizures and the outcomes. Likewise, the multivariable analysis should have been adjusted taking this predictor into consideration.
Second, the authors have reported means (standard deviations) in descriptive statistics. However, given the small sample size of the cohort in general (n = 151) and post-stroke seizure group in particular (n = 14), reporting medians (interquartile range) would be more appropriate and informative. Similarly, Mann-Whitney U test should be used instead of Students t-test when data appears skewed or else tests of normality should be explicitly reported, e.g. the Shapiro-Wilk Test. Furthermore, it is unclear what variables were entered in the multivariable model and at what significance level.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Shehta N, Fahmi RM, Ramadan BM, Emad EM, Elsaid AF. Early post-stroke seizures in a sample of Egyptian patients with first-ever stroke. Neurol India 2018;66:1031-5.  [ PUBMED] [Full text] |
| 2. | Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Cote R, et al. Seizures after stroke: A prospective multicenter study. Arch Neurol 2000;57:1617-22. |
| 3. | Denier C, Masnou P, Mapoure Y, Souillard-Scemama R, Guedj T, Theaudin M, et al. Watershed infarctions are more prone than other cortical infarcts to cause early-onset seizures. Arch Neurol 2010;67:1219-23. |
| 4. | Ferro JM. Cardioembolic stroke: An update. The Lancet Neurol 2003;2:177-88. |
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