A clinical study of late seizure (convulsion) associated with cerebral infarction

• Published in: Japanese Journal of Stroke Vol. 12; no. 4; pp. 346 - 350
• Main Authors: Yoshii, Fumihito, Yazaki, Kouji, Takahashi, Wakoh, Yamamoto, Masahiro, Shinohara, Yukito
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 1990
• Subjects: cerebral infarction; computed tomography; convulsion; late seizure; status epileptics
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.12.346

We studied the clinical features of late convulsive seizure which occurred more than two weeks after cerebral infarction. Subjects were 43 patients (26 males, 17 femles) aged from 45 to 83 years old (mean ± S.D. : 67 ± 10 years). Cerebral infarction was confirmed with either computed tomography or magnetic resonance imaging, and electroencephalography was performd within 72 hours after the convulsive seizure. The inteval between the cerebral infarction and the seizure ranged from one month to nineteen years. Twelve patients (28%) had seizures within one year and 21 patients (49%) had them within two years after cerebral infarction. The locations of cerebral infarction in 24 patients (58%) were in the cortical branch territory of the middle cerebral artery. The patients who had had cerebral infarctions in the territories of the middle cerebral artery along with the anterior or posterior cerbral arteries amounted to 79% of the subjects. The cerebral infarction was located in the perforator branch territory of the middle cerebral artery in 5 patients. None of the subjects had cerebral infarction located in either the brain stem or the cerebellum. The numbers of patients who had risk factors of cerebral infarction were as follows; 25 patients with hypertension, 8 with diabetes mellitus, 2 with atrial fibrillation, and 2 with ischemic heart disease. Late convulsive seizure occurred during the three months of November, December and January in 16 patients, although only four patients had convulsion during the three months of June, July and August. Regarding the type of convulion, 21 patients showed generalized convulsive seizures and 18 showed focal or secondary generalized seizures. On the electroencephalogram, 23 patients (54%) showed either sharp waves or spike waves, and 17 (40%) showed focal slow waves. Only two patients showed diffuse slow waves and one revealed a normal EEG. The paroxysmal waves were more likely to be detected in either the posterior portion of the frontal lobe or the anterior portion of the parietal lobe. Status epilepticus was observed in 17 patients (40%), being more likely to be occurred in elderly patients. Fifteen patients (35%) had recurrent convulsion, which was more common in patients who had had convulsion shortly after cerebral infarction.