Chapter 12 - Seizures and stroke

Summary

Stroke has long been recognized as one of the most common causes of epileptic seizures, particularly in older people. This chapter provides an overview of the various epidemiological studies on poststroke seizures (PSS) and poststroke epilepsy (PSE), and attempts to give an understanding of their pathogenesis, outcome, and management. The most consistent risk factors for PSS at stroke onset are size and cortical involvement. Abnormal electroencephalography's (EEGs) have been noted in up to 38% of patients with lacunar infarction, and lateralizing EEG abnormalities in over 80% of patients with early seizures in lacunar strokes also supports the concept of associated cortical infarction. Large, anterior circulation, ischemic strokes carry the highest risk of seizures. Patients who develop PSE usually require pharmacological treatment. Seizures following stroke occur in less than 10% of patients in the first few weeks after stroke.