Seizures After Stroke Were Uncommon And Usually Controlled

What was studied

This study looked at post-stroke epilepsy, defined here as one or more seizures occurring more than 7 days after a stroke. Researchers reviewed past medical records from one large medical center in Riyadh, Saudi Arabia, covering patients admitted between January 2016 and December 2020.

They included 2,985 people with stroke. Most had ischemic stroke (2,596 people), and 389 had hemorrhagic stroke. The researchers examined how often post-stroke epilepsy occurred, what kinds of seizures patients had, what treatments were used, and outcomes at follow-up.

What they found

Post-stroke epilepsy was found in 164 of 2,985 stroke patients, or about 5.5%. It was more frequent after hemorrhagic stroke (about 9.0%) than after ischemic stroke (about 5.0%).

The most commonly reported seizure type was generalized seizure (58.5%), followed by focal seizure (27.4%). Status epilepticus happened in 16% of patients with post-stroke epilepsy.

Most patients were started on seizure medicine after their first seizure. Levetiracetam was the most common first medicine used. Reported side effects were infrequent in the chart review, with behavioral changes and irritability mentioned most often. At a median follow-up of 26 months, 87% of patients were seizure-free. Most patients were treated with one antiseizure medicine at last follow-up.

Limits of the evidence

This was a retrospective chart review from a single hospital, so it describes what was seen in that center and may not represent all patients in Saudi Arabia or elsewhere. Because the study looked back at records, some seizures, side effects, or details may have been missed or recorded unevenly.

The diagnosis of post-stroke epilepsy was based on clinical assessment, and EEG was not required, so some cases may have been classified differently in other studies. The study also cannot determine why some patients developed epilepsy or compare how well different treatments worked.

For families and caregivers

For families, this study suggests that seizures after stroke can occur in a minority of patients, and were reported more often after hemorrhagic stroke than ischemic stroke in this cohort. It also suggests that many patients with post-stroke epilepsy were seizure-free at follow-up, often while using one anti-seizure medicine.

At the same time, some patients had serious seizure problems such as status epilepticus, so new seizure-like events after a stroke should be taken seriously and discussed promptly with a clinician.

What to watch next

Future studies could include multiple hospitals, use standardized approaches to seizure diagnosis, and further examine treatment patterns and longer-term outcomes.

Terms in this summary

post-stroke epilepsy

Epilepsy that develops after a stroke, with one or more seizures happening more than 7 days later in this study.

ischemic stroke

A stroke caused by a blocked blood vessel in the brain.

hemorrhagic stroke

A stroke caused by bleeding in or around the brain.

generalized seizure

A seizure type reported in this study as the most common; it typically involves both sides of the brain from the start.

focal seizure

A seizure that starts in one area of the brain.

status epilepticus

A prolonged seizure or repeated seizures without recovery in between; this is a medical emergency.

EEG

A test that records the brain's electrical activity.

monotherapy

Treatment using one medicine instead of several medicines together.