Clinical Characteristics of Seizures in Epilepsy after Stroke: Prognosis and Treatment

Objectives: The aim of the present study was to determine demographic properties and risk factors for early-and late-onset seizures, as well as the effects of these factors on prognosis of patients with post-stroke epilepsy. Methods: Only patients with post-stroke epilepsy were included in this retrospective study. Demographic properties, stroke type, time interval between stroke and onset of seizure, neuroimaging, EEG characteristics, antiepileptic therapy, and prognosis were assessed. Results: Forty-five patients were included; 23 (51%) were female, and 22 (49%) were male. Mean age of study population was 64.6 +/- 1.3 (23-84). Sixty percent (n= 27) of patients had early-onset seizures, and 40% (n= 18) had late-onset seizures. Thirty-four patients had an ischemic stroke, and 11 had a hemorrhagic stroke. Most prevalent etiologic factor in the ischemic strokes was a cardioembolic stroke (15%). Middle-cerebral-artery infarcts were the most frequently observed arterial stroke region. In hemorrhagic stroke lobar, hemorrhages (54%) were more prevalent, and 87% of patients received monotherapy. Levetiracetam was the most commonly preferred medication, followed by carbamazepine, valproic acid, and oxcarbazepine, in descending order. Of the early-onset seizures, 63% were controlled with medication, as were 55% of the late-onset seizures. A statistically significant difference was observed between post-stroke localization and timing of seizure. Conclusion: Post-stroke seizures may present as early-or late-onset due to various underlying pathophysiologic mechanisms and prognostic properties. These seizures are affected by a variety of factors and are frequently controlled with monotherapy.