Late-Onset seizures: Stroke Treatment and lifestyle Intervention Trial (LOSTIT)

Stroke is a leading cause of death and morbidity.

Stroke is also the most common cause of acquired epilepsy and the link between cerebrovascular disease and seizures is well described. A first seizure can precede stroke, presumably because such seizures reflect occult cerebrovascular disease.

Using Swedish national registers, we have demonstrated that about 5-20% of all patients with a first seizure after age 50 will suffer stroke within ten years.

A person that has a first seizure late in life is therefore at high risk of stroke, but evidence on management is lacking.

The proposed multicenter trial (LOSTIT) will assess the value of treating late-onset seizures as an equivalent of transitory ischemic attack and randomize patients to vascular risk factor management or standard care. The intervention will consist of blood pressure control, lipid-lowering agents, and advice on smoking cessation.

The study is end-point driven. The primary outcome measure is stroke. Secondary outcome measures are stroke severity and death. Information on outcome is extracted from the Riksstroke quality register and the Cause of Death register. Patients will be recruited from ten sites in Sweden and a number of international hospitals.

This planning project will provide us with time and funding to finalize the study protocol, including a nationwide standard clinical routine for risk factor intervention,  as well as initiate trial preparation.