Abstract
Introduction
Stroke is a sudden neurological deficit of the brain due to vascular cause. A seizure is a transient clinical condition resulting from abnormal excessive neuronal activity in the brain. Early seizures might complicate the clinical course of patients with acute stroke, including an increase in infarct size and impaired functional recovery. There is scarce evidence on the magnitude and predictors of early post stroke seizures in Ethiopia. This study aimed to determine the incidence and predictors of early seizures among stroke patients in a hospital setting, Northwest Ethiopia.
Methods
An institution-based retrospective cohort study was conducted from February 1, 2024 to May 31, 2024 for the study period between January 1, 2020 and December 31, 2023 at the University of Gondar hospital. Early post-stroke seizures were defined as seizures that occur within the first 7 days of stroke onset. Convenience sampling method was used to recruit 384 study subjects. Medical records of study subjects were reviewed and data were extracted using a data extraction format. Data were entered into Epi data version 4.6 (Epi Info, Atlanta, USA) and then exported to Stata version 18.5 statistical software (StataCorp, Texas, USA) for analysis. Binary logistic regression model was used to identify associated variables of early post-stroke seizures. A P-value < 0.05 was used to declare a significant association.
Result
The median age of study subjects was 65 (IQR = 54–73) years, and majority (57%) of study participants were males. The incidence of early post-stroke seizures was 8.6% (95% CI 6.16–11.85%). Hemorrhagic stroke (AOR = 4.63, 95% CI 1.28–16.66), elevated intracranial pressure (AOR = 3.24, 95% CI 1.07–9.78), higher National Institute of Health Stroke Scale (NIHSS) score (AOR = 1.25, 95% CI 1.14–1.36), hypertension (AOR = 4.88, 95% CI 1.39–17.14), and atrial fibrillation (AOR = 6.94, 95% CI 1.84–26.18) were identified as predictors of early post-stroke seizures.
Conclusion
The incidence of early post-stroke seizures was found to be within global reports. Hemorrhagic stroke, high NIHSS score, raised intracranial pressure (ICP), hypertension and atrial fibrillation were significantly associated with the development of early post-stroke seizures. Healthcare practitioners should recognize early and treat promptly identified risk factors to prevent the untoward effects of early post-stroke seizures.
Keywords: Seizure, Stroke, Early post-stroke seizure, Ethiopia
Introduction
Stroke is one of the main epileptogenic conditions in adults, and seizures are the most common neurological sequelae of stroke [1–3]. Early post-stroke seizure is a seizure that occurs within 7 days of stroke onset. Nearly half of early seizures occur within 24–48 h of stroke onset. Majority of early seizure types following a stroke are focal at onset [4–7]. Speculated pathophysiologic mechanisms of early post-stroke seizures include neuronal biochemical dysfunction with membrane instability, hypoxic-ischemic electrical irritable tissue depolarization, transient excitotoxic neurotransmitter (glutamate) release, free radical damage (oxidative stress), altered energy metabolism, blood brain barrier disruption, and electrolyte imbalance [2, 6, 8, 9]. Since early seizures are due to transient neural substrate changes, long term prophylactic anti-seizure medications are not indicated [8, 9]. According to a study in Europe and USA, incidence of early post-stroke seizures was 4–5% [10–13]. A Chinese meta-analysis reported that about 7% of stroke patients experienced early seizures. It was found to be 10–15% in African reports [14–16]. Prevalence of post-stroke seizures in previous Ethiopian reports was 22% to 25% [17, 18]. Western literatures reported that lobar hemorrhage, cortical involvement, anterior circulation territory stroke, and severe neurologic deficits were predictors of early seizures in stroke patients [19–24]. Cardioembolic stroke and multifocal infarcts were also apparently major risk factors for early seizures [19]. Hemorrhagic transformation of cerebral infarct after endovascular therapy (thrombolysis or thrombectomy) was identified to be a risk factor for early seizures [20]. In Egyptian individuals who experienced their first stroke, early seizures were linked to large sized lesions, cortical lesions, and intracerebral hemorrhage [15]. A Moroccan study established that stroke patients with cortical involvement, severe and large infarcts, and lobar hemorrhage were most impacted by early stroke seizures [25]. Early post-stroke seizures might complicate the clinical course of patients with acute stroke, which included an increase in infarct size and delayed functional recovery [26, 27]. In addition, post-stroke seizures impacted significant morbidities among stroke patients including more severe disability rate, impaired quality of life, prolonged hospital stay, adverse physical and mental health, and more in-hospital expenses [28, 29]. More information on risk factors of early post-stroke seizures is crucial to prevent its untoward effects. Literature on early seizures among stroke patients in Ethiopia is scanty. This study would fill in the information gap on incidence and predictors of early post-stroke seizures in the study locality.
Materials and methods
Study setting and design
A retrospective cohort study was conducted at the University of Gondar hospital, Gondar, Northwest Ethiopia, 748 km far from Addis Ababa, capital of Ethiopia. It is a multidisciplinary specialized teaching hospital where medical students are trained in both undergraduate and postgraduate programs. University of Gondar hospital is a tertiary-level referral hospital that serves as the referral center for 12 district hospitals in the area serving a total catchment of 7 million people. Stroke patients were diagnosed based on clinical symptoms, physical examination, and imaging findings (CT scan or MRI). A stroke unit with a capacity of fifteen beds was built in 2020, and coordinated by trained stroke nurses. The care is provided by neurologists, residents, interns, and nurses.
Study population and study subjects
The study population was 18 years and older stroke patients who were admitted at the University of Gondar hospital between January 1, 2020 and December 31, 2023.
The study subjects were 18 years and older stroke patients who experienced seizures within seven days of stroke onset during the study period.
Inclusion criteria and exclusion criteria
Eighteen years and older stroke patients who were admitted at the University of Gondar hospital with the diagnosis of early post-stroke seizures during the study period were included in the study. Stroke patients who had seizures or known epilepsy before the stroke, who had seizures after day 7 of stroke onset, and those with transient ischemic attack, subarachnoid hemorrhage and cerebral venous thrombosis were excluded.
Sample size and sampling procedure
The sample size was determined using the single population proportion formula with the assumption of a 95% level of confidence, a 5% margin of error, and taking 32% incidence of post-stroke seizures, and 15% non-response rate.
 |
Convenience sampling technique was used to recruit 384 study subjects [18].
Study variables
Dependent variable Early post-stroke seizure (EPSS).
Independent variables Socio-demographic characteristics- age, gender, residence, marital status; behavioral factors- alcohol drinking, cigarette smoking; clinical factors- level of consciousness (based on Glasgow Coma Scale), body sites involved, type of stroke, site of stroke, severity of stroke (based on National Institute Health Stroke Scale); laboratory values-brain imaging, echocardiography, electrocardiogram, carotid doppler ultrasound; and comorbidities- hypertension, diabetes mellitus, chronic kidney disease, cardiac arrhythmias, and structural cardiac diseases.
Data collection method and period
Pre-tested semi-structured questionnaire, which was adapted from previous studies, was prepared before the data collection. The questionnaire comprised information on socio-demographic, clinical, behavioral, and co-morbidity variables. The patients’ records were reviewed to obtain information on relevant medical history, physical signs, laboratory parameters and brain imaging findings. The questionnaire was translated into local language (Amharic) for data collection and re-translated back to English with maintaining its consistency. The data were collected from February 1 to May 31, 2024 for the study period between January 1, 2020 and December 31, 2023.
Data quality assurance
Training on the objective of the study and how to review the documents as per the data extraction format was given to data collectors. The data collectors were two general practitioners and a neurology resident. A pre-test was done on 5% of calculated sample size before the actual data collection. Medical records were identified by their medical registration numbers. Data collectors reviewed and extracted data from patients’ medical records using a data extraction format. All the collected data were checked by the supervisor for their completeness and consistency on daily basis.
Data processing and analysis
Data were entered into Epi data version 4.6 (Epi Info, Atlanta, USA), and then exported to Stata version 17 Statistical software (StataCorp, Texas, USA) for analysis. Descriptive statistics, such as median and inter quartile ranges (IQR) were used to compute continuous variables, and counts with percentage for categorical variables. Missing values were handled through multiple imputation technique. The percentage of missing data per variable was less than five percent. Imputation model used was multiple imputations by chained equations (MICE). Results were presented by using frequency, tables and figures. Multicollinearity among predictor variables was checked using the variance of inflation factor (VIF). Predictors with a VIF < 5 (1.33) were considered appropriate for inclusion in the model. The association between predictor variables and outcome variable was determined using binary logistic regression model. The model goodness of fit was tested using Hosmer and Lemeshow’s test, which yielded a value of 0.45. Variables associated with early post stroke seizures with P-value < 0.25 in the bivariable analysis were further analyzed using multivariable analysis to control for potential confounding factors. Crude odds ratio (COR) and adjusted odds ratio (AOR) were reported. A P-value < 0.05 was used to declare a significant association.
Ethical consideration
A research protocol complied with the Declaration of Helsinki. Ethical clearance was obtained from Institutional Review Board (IRB) of College of Medicine and Health Science, University of Gondar (Ref No: 1281/2024, Date: 3/1/2024). A letter of permission was obtained from the Clinical Director of University of Gondar Comprehensive Specialized Hospital before the actual data collection was started. All data obtained were treated confidentially.
Operational definition
Stroke- Syndrome of acute, focal neurological deficit attributed to vascular injury lasting > 24 h [5].
Post-stroke seizures—Seizures that occur after a stroke, without a previous history of seizures, structural brain abnormalities or other metabolic brain disease. The stroke lesion must be confirmed by neuroimaging (e.g., CT scan or MRI) and be consistent with the clinical presentation of the seizure [3, 5].
Early post-stroke seizures (Acute symptomatic seizures in stroke)—Seizures that occur within the first 7 days of stroke onset [3, 5, 6].
Urban area- A place with at least 2000 inhabitants, and 50% of the population are engaged in non-agricultural jobs [30].
Rural area- An area with inhabitants considerably dependent on agriculture for both livelihood and employment [30].
Results
Socio-demographic characteristics
A total of 384 stroke patients were included in the study from January 1, 2020 to December 31, 2023. The median age of study participants was 65 (IQR = 54–73) years, which ranged from 23 to 109 years. Among the study participants 220 (57.3%) were males, 309 (80.5%) were married, and 213 (55.5%) were rural residents. Almost all 382/384 (99.5%) of study subjects were non-smokers, and 378/384 (97.9%) didn’t consume alcohol (Table 1).
Table 1.
Socio-demographic and behavioral characteristics of patients with stroke at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2024 (N = 384)
| Variable | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Age (Years) | 23–44 | 39 | 10.16 |
| 45–64 | 145 | 37.76 | |
| ≥ 65 | 200 | 52.08 | |
| Gender | Male | 220 | 57.29 |
| Female | 164 | 42.71 | |
| Residence place | Urban | 171 | 44.53 |
| Rural | 213 | 55.47 | |
| Marital status | Married | 309 | 80.46 |
| Single | 43 | 11.20 | |
| Divorced | 16 | 4.17 | |
| Widowed | 16 | 4.17 | |
| Cigarette smoking |
No Yes |
382 2 |
99.48 0.52 |
| Alcohol intake |
No Yes |
376 8 |
97.92 2.08 |
Clinical characteristics and co-existing comorbidities
The commonest stroke type was ischemic stroke, which accounted for 262 (68.23%) cases. The remaining, 122 (31.77%), were cases of hemorrhagic stroke. Ninety-seven percent (371/384) patients suffered a unilateral stroke. Among all stroke patients, 212/384 (55.21%) individuals had subcortical involvement, which was followed by cortical involvement 135/284 (35.16%). The remaining cases, 37/384 (9.64%), had both cortical and subcortical involvement. Seventy-two percent of patients (272/384) experienced middle cerebral artery (MCA) territory stroke. Sixty-one percent (159/262) of ischemic strokes were caused by thrombosis, while the remaining, 39% (103/262) were due to embolism. Among thrombotic strokes, large vessel stroke occurred in 79/159 (50%) involving frontal, temporal and parietal lobes. In small vessel stroke (80/159), internal capsule (62/80), basal ganglia (13/80), and pons (5/80) were identified sites. In embolic stroke, partieto-temporal (61/103), parietal (32/103) and frontal (10/103) lobes were sites of cerebral embolism. In hemorrhagic stroke, basal ganglia (57/112) were the common sites of bleeding followed by lobar (32/112) and brain stem bleeding (23/112). Among hemorrhagic stroke patients, 78/122 (63.93%) had volume ≤ 30 ml, while 44/122 (36.07%) had volume > 30 ml. Seventy-nine percent (304/384) of stroke patients had stage 2 hypertension on admission (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). Seventy one percent (271/384) of stroke patients had mildly altered mentation (GCS = 13–15), and fifty-nine percent (225/384) of them had moderate severity of stroke (NIHSS score = 6–15) (Table 2). Among the co-existing co-morbidities in stoke patients, 156/384 (40.62%) had hypertension, followed by atrial fibrillation 58/384 (15.10%), valvular heart disease 36/384(9.38%), ischemic heart disease 35/384 (9.14%), and diabetes 25/384(6.51%) (Table 3; Fig. 1).
Table 2.
Clinical characteristics patients with stroke at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2024 (N = 384)
| Variable | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Systolic BP | 100–119 | 4 | 1.04 |
| 120–139 | 76 | 19.79 | |
| 140–159 | 196 | 51.04 | |
| 160–180 | 93 | 24.22 | |
| > 180 | 15 | 3.91 | |
| Diastolic BP | 60–79 | 42 | 10.94 |
| 80–89 | 108 | 28.12 | |
| 90–99 | 116 | 30.21 | |
| 100–109 | 96 | 25.00 | |
| 110–140 | 22 | 5.73 | |
| Cause of stroke | Embolic | 103 | 26.82 |
| Thrombotic | 159 | 41.41 | |
| Hemorrhagic | 122 | 31.77 | |
| Territory | ACA | 35 | 9.11 |
| MCA | 276 | 71.88 | |
| Vertebro-basilar | 73 | 19.01 | |
| GCS | 13–15 | 271 | 70.57 |
| 9–12 | 80 | 20.84 | |
| 5–8 | 33 | 8.59 | |
| NIHSS score | 1–5 | 59 | 15.36 |
| 6–15 | 225 | 58.59 | |
| > 15 | 100 | 26.05 | |
| Body sites involved | Bilateral | 13 | 3.39 |
| Unilateral | 371 | 96.61 | |
| Type of stroke | Ischemic | 262 | 68.23 |
| Hemorrhagic | 122 | 31.77 | |
| Site of stroke | Cortical | 135 | 35.16 |
| Subcortical | 212 | 55.20 | |
| Cortical-subcortical | 37 | 9.64 | |
| Volume of hemorrhage | ≤ 30 ml | 78 | 63.93 |
| > 30 ml | 44 | 36.07 |
NB: ACA Anterior cerebral artery, BP Blood Pressure, GCS Glasgow Coma Scale, MCA Middle cerebral artery, NIHSS National Institute of Health Stroke Scale
Table 3.
Comorbidities among patients with stroke at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2024 (N = 384)
| Variables | No | Percentage (%) |
|---|---|---|
| Hypertension | 156 | 40.62 |
| Diabetes mellitus | 25 | 6.51 |
| Atrial Fibrillation | 58 | 15.10 |
| VHD | 36 | 9.38 |
| IHD | 35 | 9.14 |
| Others | 30 | 7.81 |
NB: IHD Ischemic Heart Disease, VHD Valvular heart Disease; Others; Degenerative heart disease, thyrocardiac disease, dilated cardiomyopathy
Fig. 1.
Magnitude of early post-stroke seizures among patients with comorbidities at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2024 (N = 384)
Incidence of early post stroke seizures (EPSS)
The incidence of early post-stroke seizures was 8.6% (95% CI 6.16–11.85%) (Fig. 2). The incidence of early post-stroke seizures among ischemic and hemorrhagic stroke patients were 4.58% (95% CI 2.61–7.90%) and 17.21% (95% CI 11.48–24.99%), respectively.
Fig. 2.
Incidence of early post-stroke seizures (EPSS) at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2024 (N = 384)
Factors associated with early post-stroke seizure (EPSS)
On bivariable analysis, type of stroke, site of brain involvement, GCS, NIHSS score, increased intracranial pressure (ICP), hypertension and atrial fibrillation (AF) were associated with early post-stroke seizures. When variables with a P-value of < 0.25 on bivariable analysis were entered into multivariable analysis, only the stroke type, NIHSS score, elevated intracranial pressure (ICP), atrial fibrillation and hypertension were found to be significantly associated with early post-stroke seizures. According to this study, patients with hemorrhagic stroke had fivefold (AOR = 4.63, 95% CI 1.28–16.66) higher risk of experiencing an early post-stroke seizures than patients with ischemic stroke. Individuals with a higher NIHSS score were 1.13 times (AOR = 1.13, 95% CI 1.01–1.27) more likely than those with a lower score to experience EPSS. Stroke patients with elevated ICP had threefold greater risk (AOR = 3.24, 95% CI 1.07–9.78) of developing EPSS compared to those without elevated ICP. In comparison to patients without concomitant hypertension and atrial fibrillation, those with co-existing hypertension and atrial fibrillation were five times (AOR = 4.88, 95% CI 1.39–17.14) and seven times (AOR = 6.94, 95% CI 1.84–26.18) more likely to develop EPSS, respectively (Table 4).
Table 4.
Bivariable and Multivariable logistic regression analysis of predictors of EPSS among stroke patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2024 (N = 384)
| Variable | Category | Mean | EPSS | COR (95% CI) | P value | AOR | P value | |
|---|---|---|---|---|---|---|---|---|
| No | Yes | |||||||
| Age | 62.93 ± 14.0 | 62.71 ± 13.71 | 65.27 ± 17.33 | 1.09(0.63–1.88) | 0.75 | – | – | |
| Gender | Male | 200 | 20 | 1.16(0.56–2.40) | 0.68 | – | – | |
| Female | 151 | 13 | 1.00 | – | – | |||
| GCS | 13.22 ± 2.40 | 13.48 ± 2.24 | 10.54 ± 2.45 | 0.67(0.59–0.77) | < 0.0001 | 0.86(0.68–1.09) | 0.225 | |
| Type of stroke | Ischemic | 250 | 12 | 1.00 | – | – | – | |
| Hemorrhagic | 101 | 21 | 4.33 (2.05–9.13) | < 0.0001 | 4.63(1.28–16.66) | 0.019 | ||
| Increased ICP | No | 322 | 17 | 1.00 | – | – | – | |
| Yes | 29 | 16 | 10.45(4.78–22.82) | < 0.0001 | 3.24(1.07–9.78) | 0.037 | ||
| AF | No | 302 | 24 | 1.00 | – | – | – | |
| Yes | 49 | 9 | 2.31(1.01–5.26) | 0.046 | 6.94(1.84–26.18) | 0.004 | ||
| Hypertension | No | 217 | 11 | 1.00 | – | – | – | |
| Yes | 134 | 22 | 3.23(1.52–6.89) | 0.002 | 4.88(1.39–17.14) | 0.013 | ||
| NIHSS score | 12.19 ± 5.71 | 11.48 ± 5.02 | 19.81 ± 6.97 | 1.31(1.21–1.42) | < 0.0001 | 1.25(1.14–1.36) | < 0.0001 | |
NB: AOR Adjusted odds ratio, AF Atrial fibrillation, CI Confidence interval, COR Crude odds ratio, EPSS early post-stroke seizure, GCS Glasgow coma scale, ICP Intracranial pressure, NIHSS National institute of health stroke scale
Discussion
The incidence of early post-stroke seizures (EPSS) was found to be 8.6% (95% CI 6.16–11.85%). Reports from Western world had shown lower incidence of EPSS (2.4–5.5%) [19, 31]. Comparable findings were reported from Nigeria (9.3%) and Egypt (9.9%) [14, 15]. Higher incidence of early seizures was documented in Morocco (13.0%), India (12.7%) and previous reports from Ethiopia (22–25%) [17, 18, 23, 25]. Lack of continuous electroencephalographic (cEEG) monitoring in this study might have underreported the actual incidence of early seizures. The varied incidences of early post stroke seizures (EPSS) among different regions of the world could be explained by differences in patient characteristics, approaches to diagnosis, post-stroke patient care and study methodologies. To explain further, older adults with cardiovascular comorbidities were more likely to experience early seizures after stroke. Different time window for early seizure definition (seizure within 24–48 h, 1 week, 2 weeks, or 30 days of stroke onset), differences in quality of health care services for prompt diagnosis of early seizures (such as cEEG monitoring use), and retrospective Vs prospective study design in observational studies determine varied incidence in post-stroke early seizures (14,15,19,23,25,31). In this study, as compared to ischemic stroke, hemorrhagic stroke carried a higher risk (AOR = 4.63, 95% CI 1.28–16.66) of developing early seizures. This finding is consistent with Western studies and West African reports [4, 15, 25, 31–33]. Sudden expansion of hematoma with local ischemia and direct irritation of the cortex by the blood products might contribute to seizure activity [32]. Patients who had raised intracranial pressure (ICP) were at higher risk (AOR = 3.24, 95% CI 1.07–9.7) of developing early seizures. A study done in Asia revealed similar findings [32]. EPSS following elevated ICP may be due to collateral perfusion failure and neuronal dysfunction causing neuronal hyper-excitability and decreased seizure threshold. Patients with higher NIHSS scores were more likely (AOR = 1.13, 95% CI 1.01–1.27) to develop early seizures. This finding was congruent with studies conducted in Western world and African reports [15, 25, 33–35]. The likelihood of having EPSS rose by 29% when the NIHSS score increased by 5 units [33]. Studies have shown that post-stroke severe neurological impairment increased the risk of acute symptomatic seizures [32, 33]. Patients who had hypertension were at higher risk (AOR = 4.88, 95% CI 1.39–17.14) of developing early seizures. This finding is in line with the study done in Europe [36]. Intra-cerebral hemorrhage due to direct effect of uncontrolled hypertension could result in glutamate excitotoxicity, neuronal ionic channel disruption, trans-membrane depolarization, and lowering of the seizure threshold [2, 6]. Individuals with atrial fibrillation (AF) had increased risk (AOR = 6.94, 95% CI 1.84–26.18) of developing early seizures. Comparable findings were reported in studies conducted in Western countries [34, 37]. Individuals with AF frequently experienced multifocal and large sized cortical strokes, which raised the possibility of early post-stroke seizures. The combination of ischemic brain injury and excitotoxicity in ischemic penumbra region could contribute to the lower threshold for early seizures [2, 6]. Younger age (< 65 years), male gender, cortical brain involvement, and lower Glasgow Coma Scale (GCS) were found to be significant predictors of early seizure in other studies, which were not in favor of this study. Difference in socio-demographic and clinical characteristics might contribute for these contrasting findings [14, 15, 21, 27, 38].
Limitation of the study
Diagnoses of early post-stroke seizures were clinical. Subclinical seizures which required EEG tracing for diagnosis were not included, and it might contribute to under reporting of the actual incidence of EPSS. Convenience sampling method might introduce selection and information bias. Strict causal relationship between predictors and outcome of early post-stroke seizures couldn’t be inferred because of the nature of study design. It was a single center hospital-based study, and conclusion could not be drawn for the general population.
Conclusion
This study showed that the incidence of early post-stroke seizures was 8.6% (95% CI 6.16–11.85%), which was within the range of global reports. Hemorrhagic stroke, high NIHSS score, raised intracranial pressure (ICP), hypertension and AF (atrial fibrillation) were significantly associated with the development of early post-stroke seizures. Health care practitioners should recognize early and treat promptly identified risk factors to prevent the untoward effects of early post-stroke seizures.
Acknowledgements
We would like to acknowledge the study participants for their willingness, and data collectors and supervisors for their valuable support and assistance during this work. We would like to extend our great deal of acknowledgement to the neurology staff members for their provision of different data collection tools.
Abbreviations
- AF
Atrial fibrillation
- AOR
Adjusted odds ratio
- ASS
Acute symptomatic seizure
- AHA
American Heart Association
- CI
Confidence Interval
- CMHS
College of Medicine and Health Science
- COR
Crude odds ratio
- DBP
Diastolic blood pressure
- DM
Diabetes mellitus
- ECG
Electrocardiogram
- EPSS
Early post-stroke seizure
- GCS
Glasgow coma scale
- ICP
Intracranial pressure
- NIHSS
National Institute of Health Stroke scale
- PSE
Post stroke epilepsy
- PSS
Post stroke seizure
- SBP
Systolic blood pressure
- UOG
University of Gondar
Author contributions
Conceptualization: Abebe Gelaw, Abilo Tadesse, Nebiyu Bekele, Guadie Beyazn Data curation: Abebe Gelaw, Abilo Tadesse, Berhanu shetie, Guadie Beyazn, Deresse Abebe, Melaku Tadesse, Yilkal Yehuala, Hailemariam Yohannes, Zeleke W/Yohannes, Nebiyu Bekele, Abebe Worku Formal analysis: Abebe Gelaw, Abilo Tadesse, Melaku Tadesse Investigation: Abebe Gelaw, Abilo Tadesse, Berhanu shetie, Guadie Beyazn, Deresse Abebe, Melaku Tadesse, Yilkal Yehuala, Hailemariam Yohannes, Zeleke W/Yohannes, Nebiyu Bekele, Abebe Worku Supervision: Abilo Tadesse, Nebiyu Bekele, Guadie Beyazn, Melaku Tadesse Visualization: Abebe Gelaw, abilo Tadesse, Berhanu shetie, Guadie Beyazn, Deresse Abebe, Melaku Tadesse, Yilkal Yehuala, Hailemariam Yohannes, Zeleke W/Yohannes, Nebiyu Bekele, Abebe Worku.
Funding
Funding for research was obtained from the ‘Research and Publication Office’ of College of Medicine and Health Sciences, University of Gondar. The funding body had no role in the design of the study, data collection, analysis and interpretation of the data.
Data availability
All data generated and analyzed were included in this research article.
Declarations
Ethics approval and consent to participate
Ethical approval was obtained from the Institutional Review Board of College of Medicine and Health Sciences, University of Gondar. Formal letter of permission was obtained from the University of Gondar hospital administrative body.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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