Seizure and epilepsy after stroke

Seizures and status epilepticus may be an early (< 7-14 days) or late (> 14 days) complication of acute stroke. Epilepsy, defined by at least two unprovoked epileptic seizures, may also be a late complication. Several risk factors have been identified for early and late seizures. Early seizures are more frequent in severe and disabling ischemic strokes, hemorrhagic strokes and those with corticol involvement. The risk of epilepsy is higher for patients with early seizures or cortical infarctions and in severely handicapped patients. Overall, approximately 4% of patient with an acute stroke will have at least one seizure in the early or late period, and half of them will develop epilepsy. Neither early nor late seizures appear to have a significant impact on mortality although status epilepticus remains a life-threatening and often fatal event. The decision whether to start antiepileptic treatment after a first seizure or wait for a recurrence remains controversial. Risk of drug interactions and adverse effects in stroke patients must be kept in mind when prescribing antiepileptic drugs.