Mark N. Rubin, MD
 
Arntz RM, Rutten-Jacobs LCA, Maaijwee NAM, Schoonderwaldt HC, Dorresteijn LDA, van Dijk EJ, and de Leeuw FE. Poststroke Epilepsy Is Associated With a High Mortality After a Stroke at Young Age: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation Study. Stroke. 2015 
 
As if decades of disability or premature death is not enough for young adults who suffer an ischemic stroke, the development of post-stroke epilepsy – which is not entirely rare – is associated with a dramatic climb in short- and long-term post-stroke mortality. 

The authors of this study bring us the results of a large Dutch cohort (631 patients) recruited over a 30 year period (1980-2010) with substantial follow up (mean 12.5 years) scrutinizing the association between post-stroke epilepsy and mortality in young adults (age 18-50 years). Overall 76 of the patients (~12%) developed epilepsy in their post-stroke course. The cumulative 30-day case fatality difference was astounding: 27.4% vs 2.1% in those with and without post-stroke epilepsy, respectively. After adjusting for confounders, the development of epilepsy remained independently associated with mortality (HR 4.8, 95% CI 1.7-14), with the index stroke being the major cause of death in these patients.

There are other data that provide nuance to the consideration of post-stroke epilepsy as a reason to raise the hairs on the back of a provider’s neck, but the punchline is thus: a stroke severe enough to cause a seizure is also severe enough to take a life. It’s a Biomarker of Badness, although not quite so bad being singled out by Oscar!