Mar 10, 2024
Poststroke epilepsy is a common complication of stroke, and its incidence has increased due to the high survival rates of acute stroke thanks to medical and technological advancements. The incidence of poststroke epilepsy ranges from 2% to 20%, with a higher incidence overall after hemorrhagic stroke and subarachnoid hemorrhage. In a prospective multicenter study, the overall incidence of seizures was approximately 10.6% following hemorrhagic cerebrovascular diseases and approximately 8.6% after ischemic strokes.
Studies use different threshold times to classify post-stroke seizures based on the time of occurrence after stroke. The most commonly used cut-off times to describe early and late-onset seizures are 7 days or 14 days. One study found the risk of developing subsequent seizures within 10 years after an unprovoked seizure in the late post-stroke period (> 1 week) to be 71.5%, and as high as 33.0% in early seizures (< 1 week). This means that a patient with a single, isolated, and unprovoked seizure after stroke meets the criteria for a diagnosis of epilepsy. Therefore, the initiation of antiepileptic drugs may be considered in patients with a high risk of seizure recurrence, even if they have a single seizure after stroke.
The seizure onset time interval after stroke is the most important risk factor for the development of poststroke epilepsy. Most poststroke epileptic seizures (approximately 70-90% of these) occur within the first 24 hours of cerebrovascular disease due to transient local irritation from underlying excitotoxicity and local and systemic metabolic derangements. Most clinicians believe that early seizures are triggered and generally do not associate them with an increased risk of recurrent seizures and epilepsy. Seizures occurring within 7 days of stroke are 33% likely to cause poststroke epilepsy within the next 10 years, which is significantly less than common seizures. Early seizures have a lower prevalence of recurrent seizures compared to general seizures and are 16 times more likely to develop poststroke epilepsy compared to stroke patients without any seizures. Generalized seizures are likely to occur due to a persistent focal lesion following hemorrhage or ischemic stroke and are associated with a significantly higher risk of developing poststroke epilepsy compared to early seizures. The highest incidence of generalized seizures appears to be in the 6-12 months post-stroke period.
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