Poststroke epilepsy linked to major vascular cognitive disorder

In young stroke survivors, poststroke epilepsy is independently associated with major vascular cognitive disorder, with impairment in the attention and working memory cognitive domains, according to a multicentre prospective cohort study.

The study included 482 adult patients aged 18–49 years who sustained a first-ever transient ischaemic attack, ischaemic stroke, or primary intracerebral haemorrhage. Cognitive function was evaluated 1 year after the event, and composite z-scores were calculated for seven cognitive domains. Vascular cognitive disorder was categorized as mild (ie, composite z-score in any domain of between −2.0 and −1.5 SD) and major (ie, composite z-score in any domain of less than −2.0 SD).

Over a total of 1,228.8 person-years of follow-up, post-stroke epilepsy occurred in 20 patients (PSE group). Compared with the control group with no post-stroke epilepsy, the PSE group were slightly younger (median age 38.6 vs 44.2 years) and less likely to be male (30 percent vs 50 percent). The median NIHSS scores did not differ between the two groups (2 vs 2).

The odds of major vascular cognitive disorder were around fourfold higher in the PSE group than in the control group (40 percent vs 20.1 percent; adjusted odds ratio [OR], 3.96, 95 percent confidence interval [CI], 1.24–12.65).

Furthermore, the PSE group had fivefold higher odds of cognitive impairment in the attention and working memory domain (adjusted OR, 5.09, 95 percent CI, 1.15–22.59).

The findings support the “second-hit hypothesis,” stating that epilepsy following a primary injury contributes to the development of cognitive impairment.