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Post-stroke Seizures

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Management of Post-Stroke Complications

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Abstract

Seizures affect between 4 and 6 % of patients within a week of stroke, and between 2.5 and 6.5 % of patients will develop epilepsy post-stroke. Incidence estimates are particularly variable due to differing definitions, study methodologies, populations, and follow-up durations. Stroke types such as subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH), and large-volume cortical infarct are likely risk factors.

Investigations should be undertaken to rule out alternative diagnoses such as cardiac disease causing syncope and non-stroke causes of seizures including electrolyte and metabolic abnormalities, malignancy, and drug or alcohol withdrawal. Due to the large number of possible explanations for seizure-like activity, MR imaging is recommended and EEG may be considered to support a probable diagnosis of post-stroke epilepsy. Where the diagnosis remains uncertain, ambulatory monitoring and video telemetry may be helpful.

With the exception of status epilepticus, which requires urgent intervention, antiepileptic drugs should be initiated in a specialist setting after formal diagnosis of epilepsy, taking into account the patient’s age, gender, childbearing potential, comorbidity, and medication history.

A diagnosis of epilepsy has significant psychosocial effects, particularly related to restrictions on driving, which must be addressed appropriately. The DVLA (Driver and Vehicle Licensing Agency) has specific rules where provoked seizures are concerned. Although most patients achieve long-term seizure remission with therapy, epilepsy has been independently associated with greater mortality post-stroke.

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Author information

Authors and Affiliations

  1. National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK

    Neil S. N. Graham BA, MBBS, MRCP

  2. Department of Neurology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK

    Paul A. Holmes MD, FRCP

  3. Division of Health and Social Care Research, King’s College London, London, UK

    Anthony G. Rudd FRCP

Authors
  1. Neil S. N. Graham BA, MBBS, MRCP
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  2. Paul A. Holmes MD, FRCP
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  3. Anthony G. Rudd FRCP
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Corresponding author

Correspondence to Neil S. N. Graham BA, MBBS, MRCP .

Editor information

Editors and Affiliations

  1. Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

    Ajay Bhalla

  2. Department of Ageing & Health, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

    Jonathan Birns

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Graham, N.S.N., Holmes, P.A., Rudd, A.G. (2015). Post-stroke Seizures. In: Bhalla, A., Birns, J. (eds) Management of Post-Stroke Complications. Springer, Cham. https://doi.org/10.1007/978-3-319-17855-4_4

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  • DOI: https://doi.org/10.1007/978-3-319-17855-4_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17854-7

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