The risk of new-onset epilepsy and refractory epilepsy in older adult stroke survivors
Bibliographic record
Abstract
Objective Our study objectives were to identify factors associated with new-onset epilepsy and refractory epilepsy among older adult stroke survivors and to evaluate the receipt of diagnostic care and mortality for participants who developed epilepsy. Methods We conducted a population-based, retrospective cohort study using linked, administrative health care databases. The Ontario Stroke Registry was used to identify patients 67 years and older who were hospitalized for a stroke at a designated stroke center in Ontario, Canada, between April 1, 2003, and March 31, 2009, and were previously free of epilepsy. Multivariable Fine–Gray hazard models were used to examine risk factors of epilepsy and refractory epilepsy, accounting for the competing risk of death. Results Among 19,138 older adults hospitalized for a stroke, 210 (1.1%) developed epilepsy and 27 (12.9%) became refractory to antiepileptic drugs. Within 1 year of epilepsy diagnosis, 24 (11.4%) patients were assessed with EEG and 19 (9.0%) with MRI. In multivariable analysis, younger age and thrombolysis receipt significantly increased epilepsy risk. Lesser stroke severity and anticoagulant medication receipt also significantly increased epilepsy risk; however, these effects decreased over time. Younger age and female sex were the only risk factors of refractory epilepsy. In the 5 years following epilepsy diagnosis, 97 (46.2%) participants died of any cause. Conclusions Older adult stroke survivors are less likely to develop epilepsy and pharmacologically refractory epilepsy. An estimated 86.6% of deaths among older adult stroke survivors with new-onset epilepsy are attributed to causes other than stroke or epilepsy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".