SUMMARYObjectives: To verify the net effect of seizures after stroke on the use of in-hospital health care resources. Methods: Consecutive patients with first-ever stroke were admitted to the stroke unit of a Moscow hospital and followed prospectively until death or discharge. Each patient experiencing seizures was matched for age, sex, stroke type, National Institutes of Health Stroke Scale score at admission, and stroke risk factors to 2+ patients with no seizures, as controls. Resources consumed included length of hospital stay, admission to the intensive care unit (ICU), diagnostic tests, medical consultations and treatments. Cost estimates were based on the Russian National Health Service perspective. Results: The sample comprised 30 patients with in-hospital seizures and 70 matched controls. Patients dying in hospital were 15 of 30 (50%) versus 4 of 70 (5.7%) (p < 0.001). The overall cost of hospital stay was only slightly (nonsignificantly) higher in patients with seizures, but the cost was significantly higher in patients who died than in patients who were discharged alive. Compared to the controls, patients with seizures spent more intensive care unit (ICU) days and required more computed tomography (CT) scans, x-rays, endoscopies, and specialist consultations, causing higher inhospital costs. Significance: In patients with first-ever stroke, seizures per se do not increase the overall in-hospital costs. However, the higher than expected mortality in patients with seizures is associated with additional hospital costs. KEY WORDS: Seizures, Epilepsy, Stroke, Direct costs, Treatment, Russia.Seizures and epilepsy are a common complication of stroke. Early (acute symptomatic) seizures tend to occur in up to 6% of cases 1-3 and late (unprovoked) seizures in 2-4%, 4 carrying increased morbidity and mortality after stroke.5 In Russia, cerebrovascular disease was identified as the etiology of epilepsy in 12.3% of cases with localizationrelated epilepsies, with the highest proportion (15%) in the western areas of the country, including Moscow. 6 Risk factors for seizures and epilepsy include stroke severity, cortical lesions, and type and degree of functional disability. 3,7,8 These factors, along with comorbidities in patients presenting seizures after stroke, may partly explain at least the more ominous prognosis, and consequently the burden of the disease and its costs, in patients with poststroke seizures and epilepsy compared to individuals who do not develop seizures.A disabling stroke is associated with higher direct costs.
9Epilepsy itself is a substantial socioeconomic burden at different levels in Europe. 10 However, in published reports, the net effect of epilepsy and seizures on the outcome of the disease and resource consumption has not been disentangled
