Post-stroke seizures: review article


  • Nataliia Chemer Kyiv Regional Clinical Hospital, Stroke Center, Kyiv, Ukraine, Ukraine
  • Lesia Shevchenko Kyiv Regional Clinical Hospital, Stroke Center, Kyiv, Ukraine, Ukraine



epilepsy, stroke, seizures, treatment


There is a tendency towards growing number of strokes in aging population. One of the most significant complications of stroke is post-stroke seizures (PSS), which cause nearly 11 % of all cases of epilepsy. The most important risk factors of seizures after stroke are severity of the stroke, involvement of the cortex and intracerebral hemorrhage. There are two mains forms of PSS — early- and late-onset seizures. The pathogenesis of early-onset seizures is mainly due to cytotoxic and metabolic changes in the ischemic focus in contrast to late-onset seizures, which mostly occur as a result of persistent changes in nervous system excitability. There are following types of seizures in adult patients with post-stroke complications: simple partial, generalized tonic-clonic and generalized seizures. Evaluation of electroencephalography and computed tomography results is an important diagnostic tool of the first line. At the same time, brain magnetic resonance imaging and magnetic resonance angiography are the more preferable methods of neuroimaging due to their more informative grade in detecting cortical malformations, small lesions and cavernomas. Pharmacological management of PSS is traditionally divided into two main categories: prophylactic and symptomatic treatment. Prophylactic antiepileptic treatment in stroke patients, including those with intracerebral haemorrhage to prevent an attack, is not recommended by the American Heart Association and European Stroke Organisation guidelines. Some authors indicate that diuretics, in particular thiazides and furosemide, may be protective, reducing the risk of seizures. Carbamazepine, sodium valproate, lamotrigine, oxcarbazepine or gabapentin are the most used symptomatic drugs recommended as a first-line treatment.


Camilo O., Goldstein L.B. Seizures and epilepsy after ischemic stroke. Stroke. 2004. 35. 1769-1775.

Luhdorf K., Jensen L.K., Plesner A.M. Etiology of seizures in the elderly. Epilepsia. 1986. 27(4). 458-463.

Olsen T.S. Post-stroke epilepsy. Curr. Arthroscler. Rep. 2001 Jul. 3(4). 340-344.

Yang H., Rajah G., Guo A., Wang Y., Wang Q. Pathogenesis of epileptic seizures and epilepsy after stroke. Neurol. Res. 2018. 40(6). 426-432.

Silverman I.E., Restrepo L., Mathews G.C. Poststroke seizures. Arch. Neurol. 2002 Feb. 59(2). 195-201.

Marian Galovic et al. Prediction of late seizures after ischaemic stroke with a novel prognostic model (The SeLECT Score): a multivariable prediction model development and validation study. Lancet Neurol. 2018 Feb. 17(2). 143-152.

Charlotte Germonpré, Robrecht Raedt, Paul Boon, Veerle De Herdt. Early seizures following hemorrhagic stroke in the rat collagenase model. 13th National Congress of the Belgian Society for Neuroscience, Brussels, Belgium, May 24, 2019.

Bladin C.F., Alexandrov A.V., Bellavance A., Bornstein N., Chambers B., Coté R., Lebrun L., Pirisi A., Norris J.W. Seizures after stroke: a prospective multicenter study. Arch. Neurol. 2000 Nov. 57(11). 1617-22.

Kilpatrick C.J., Davis S.M., Tress B.M., Rossiter S.C., Hopper J.L., Vandendriessen M.L. Epileptic seizures in acute stroke. Arch. Neurol. 1990. 47. 157-169.

Myint P.K., Staufenberg E.F.A., Sabanathan K. Post-stroke seizure and post-stroke epilepsy. Postgrad. Med. J. 2006 Sep. 82(971). 568-572.

Szaflarski J.P., Rackley A.Y., Kleindorfer D.O., Khoury J., Woo D., Miller R., Alwell K., Broderick J.P., Kissela B.M. Incidence of seizures in the acute phase of stroke: a population-based study. Epilepsia. 2008. 49(6). 974-981.

Rossi C., De Herdt V., Dequatre-Ponchelle N., Hénon H., Leys D., Cordonnier C. Incidence and predictors of late seizures in intracerebral hemorrhages. Stroke. 2013. 44(6). 1723-1725.

Xu M.Y. Poststroke seizure: optimising its management. Stroke and Vascular Neurology. 2019. 4. e000175.

Sitajayalakshmi S., Mani J., Borgohain R., Mohandas S. Post stroke epilepsy. Neurology India. 2002 Dec. 50(1). S78-S84.

Wen-Jing Xie, Ming Dong, Qun Liu, Hong-Mei Meng. Early predictors and prevention for post-stroke epilepsy: changes in neurotransmitter levels. Translational Neuroscience. 7(1). Published online: 18 Feb 2016.

Cordonnier C., Hénon H., Derambure P., Pasquier F., Leys D. Influence of pre-existing dementia on the risk of post-stroke epileptic seizures. J. Neurol. Neurosurg. Psychiatry. 2005. 76(12). 1649-1653.

Conrad J., Pawlowski M., Dogan M., Kovac S., Ritter M.A., Evers S. Seizures after cerebrovascular events: risk factors and clinical features. Seizure. 2013. 22(4). 275-282.

Şadiye Gümüşyayla, Gönül Vural. Early seizures after stroke: neurology intensive care unit experience. Turk. J. Neurol. 2018. 24(1). 49-54.

Shiho Okuda, Shin Takano, Masao Ueno, Hirotoshi Hamaguchi, Fumio Kanda. Clinical Features of late-onset poststroke seizures. Journal of Stroke and Cerebrovascular Disease. 2012. 21(7). 583-586.

Rosane Brondani, Andrea Garcia de Almeida, Pedro Abrahim Cherubini, Thaís Leite Secchi, Marina Amaral de Oliveira, Sheila Cristina Ouriques Martins, Marino Muxfeldt Bianchin. Risk factors for epilepsy after thrombolysis for ischemic stroke: a cohort study. Front. Neurol. 2020 Jan 23.

Lahti A.-M., Saloheimo P., Huhtakangas J. et al. Poststroke epilepsy in long-term survivors of primary intracerebral hemorrhage. Neurology. 2017. 88(23). 2169-75.

Yum A., Shvarts V. Ictal and interictal epileptiform electroencephalogram patterns. In: V. Wasade, M. Spanaki (eds). Understanding epilepsy: a study guide for the boards. 2019. 239-250.

Carla Bentes, HugoMartins, Ana Rita Peralta, Carlos Morgado, Carlos Casimiro, Ana Catarina Franco, Ana Catarina Fonseca, Ruth Geraldes, Patrícia Canhão, Teresa Pinho e Melo, Teresa Paiva, José M. Ferro. Early EEG predicts poststroke epilepsy. Epilepsia Open. 2018 Jun. 3(2). 203-212.

Siddiqui M., Yaqoob U., Bano A., Malik A., Khan F.S., Siddiqui K. EEG findings in post stroke seizures: an observational study. Pak. J. Med. Sci. 2008. 24(3). 386-389.

Mecarelli O., Pro S., Randi F. et al. EEG patterns and epileptic seizures in acute phase stroke. Cerebrovasc. Dis. 2011. 31. 191-198.

Joseph W. Doria, Peter B. Forgacs. Incidence, implications and management of seizures following ischemic and hemorrhagic stroke. Curr. Neurol. Neurosci. Rep. 2019 May 27. 19(7). 37.

Zelano J. Poststroke epilepsy: update and future directions. Ther. Adv. Neurol. Disord. 2016. 9(5). 424-435.

Guo J., Li J. et al. Statin treatment reduces the risk of poststroke seizures. Neurology. 2015. 85(8). 701-707.

Winstein C.J., Stein J., Arena R., Bates B., Cherney L.R., Cramer S.C., Deruyter F., Eng J.J., Fisher B., Harvey R.L., Lang C.E., MacKay-Lyons M., Ottenbacher K.J., Pugh S., Reeves M.J., Ri-chards L.G., Stiers W., Zorowitz R.D., American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016 Jun. 47(6). e98-e169.

Scottish Intercollegiate Guidelines Network (SIGN) Guideline 70. Diagnosis and management of epilepsy in adults. 2003.

National Institute of Health and Clinical Excellence (NICE) CG20. The diagnosis and management of the epilepsies in adults and children in primary and secondary care. 2004.

Oros M.M., Smolanka V.I., Sofilkanich N.V., Borovik O.I., Luts V.V., Andrukh P.G. Epilepsy after ishemic stroke: is it worth administering anticonvulsants after the first attack? Wiad. Lek. 2018. 71(2, pt 1).269-272.

Consoli D., Bosco D., Postorino P., Galati F., Plastino M., Perticoni G.F., Ottonello G.A., Passarella B., Ricci S., Neri G., Toni D., EPIC Study. Levetiracetam versus carbamazepine in patients with late poststroke seizures: a multicenter prospective randomized open-label study (EpIC Project). Cerebrovasc. Dis. 2012. 34(4). 282-9.

Konrad J. Werhahn, Eugen Trinka et al. A randomized, double-blind comparison of antiepileptic drug treatment in the elderly with new-onset focal epilepsy. Epilepsia. 2015 Mar. 56(3). 450-9.

Young Noh, Dong Wook Kim, Kon Chu, Soon-Tae Lee, Keun-Hwa Jung, Hye-Jin Moon, Sang Kun Lee. Topiramate increases the risk of valproic acid-induced encephalopathy. Epilepsia. 2013 Jan. 54(1). e1-4.

Sang Kun Lee. Epilepsy in the elderly: treatment and conside-ration of comorbid diseases. J. Epilepsy Res. 2019 Jun. 9(1). 27-35.

Gaetano Zaccara, Emilio Perucca. Interactions between antiepileptic drugs, and between antiepileptic drugs and other drugs. Epileptic Disorders. 2014 Dec. 16(4). 409-31.

Tim J. von Oertzen, Eugen Trinka, Natan M. Bornstein. Levetiracetam and non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and epilepsy: a reasonable combination. European Heart Journal. 2019 Dec 7. 40(46). 3800-3801.

Francisco Sales, João Chaves, Rob McMurray, Rui Loureiro, Hélder Fernandes, VicenteVillanueva. Eslicarbazepine acetate in post-stroke epilepsy: clinical practice evidence from Euro-Esli. Acta Neurol. Scand. 2020 Jul. doi: 10.1111/ane.13323.