Risk of poststroke epilepsy low among young adults, reveals JAMA study

A new study published in the Journal of American Medical Association showed that young individuals had a comparatively low risk of poststroke epilepsy (PSE), and the parameters for the current risk scores can be applied to identify young patients at high risk.

Poststroke epilepsy patients frequently require long-term antiepileptic medication, which might have negative side effects, including depression, lethargy, lightheadedness, and behavioral abnormalities. Esmée Verburgt and her team therefore carried out this study to confirm existing PSE risk scores among a cohort of young individuals and to look into the risk of and risk factors for PSE at an early age.

Data from the ODYSSEY (Observational Dutch Young Symptomatic Stroke Study), a prospective cohort study that was carried out across 17 Dutch hospitals from May 27, 2013, to March 3, 2021, with follow-up until February 28, 2024, were used in this investigation. The primary exposure was the first ischemic stroke, or ICH, to be confirmed by neuroimaging.

Nearly, 1388 consecutive patients, between ages 18 to 49, who had no history of epilepsy and had an ischemic stroke or intracerebral hemorrhage (ICH) confirmed by neuroimaging were included in the study and 57 (4.1%) of them experienced PSE.

Following an ischemic stroke, the 5-year cumulative risk of PSE was 3.7%, and following an ICH, it was 7.6%. Following an ischemic stroke, PSE was linked to cortical involvement and an abrupt symptomatic seizure (less than seven days). Only cortical engagement was linked to PSE following ICH. Both scores had satisfactory calibration, with the C statistic for the SeLECT 2.0 risk score being 0.78 and the CAVE risk score being 0.83.

Overall, this research found that young persons with ischemic stroke or ICH had a comparatively low incidence of PSE, which peaked in the first year following the stroke. Existing risk scores can be utilized to accurately tell young patients about their risk of PSE and may be applied to patients who have had a stroke at an early age. For high-risk individuals, future clinical studies should examine the best main and secondary prophylactic measures.

Source:

Verburgt, E., Fellah, L., Ekker, M. S., Schellekens, M. M. I., Boot, E. M., Immens, M. H. M., van Alebeek, M. E., Brouwers, P. J. A. M., Arntz, R. M., van Dijk, G. W., Gons, R. A. R., van Uden, I. W. M., den Heijer, T., van Tuijl, J. H., de Laat, K. F., van Norden, A. G. W., Vermeer, S. E., van Zagten, M. S. G., van Oostenbrugge, R. J., … de Leeuw, F.-E. (2025). Risk of poststroke epilepsy among young adults with ischemic stroke or intracerebral hemorrhage. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2025.0465