Abstract Details

The burden of and risk factors for PSE among patients presenting with acute stroke in resource-limited settings is unknown, especially in sub-Saharan Africa. 

Investigate risk factors for post-stroke epilepsy (PSE) and their association with clinical factors among adults with acute stroke at the University Teaching Hospital (UTH) in Lusaka, Zambia.

A prospective cohort of adults (>18 years old) admitted to the neurology service at UTH with suspected or confirmed stroke was conducted between November 2021 and August 2022. PSE was defined as any self- or caregiver-reported seizure occurring within one year of post-discharge follow-up.  Acute seizures were those occurring at stroke onset or during inpatient stroke hospitalization.  Participant demographics, stroke type and clinical characteristics were compared between those with and without PSE using t-tests, chi-square analyses, and Wilcoxon rank-sum tests as appropriate.

Of 316 participants who survived acute hospitalization, 13 (4%) PSE, including 10% (n=4) of the 42 participants who had acute seizures and 3% (n=9) of the 274 participants without acute seizures. Amongst those with acute seizures and PSE, 75% were people with HIV compared to only 20% of participants who experienced acute seizures but did not develop PSE (p=0.04).  Amongst those without acute seizures, 33% (n=3) of those with PSE had a history of a prior stroke compared to only 12% (n=32) of those without PSE (p=0.07).  Development of PSE did not differ by demographic characteristics, stroke type (ischemic versus hemorrhagic; large vessel occlusion vs other), or non-HIV comorbid conditions.

Adults with HIV and stroke who experience acute seizures were significantly more likely to develop PSE than their HIV-uninfected counterparts, suggesting this group should be closely monitored and managed with long-term antiseizure medications.  Future work should explore mechanisms for this increased risk of PSE among people with HIV and acute seizures.