Stroke-related seizures and epilepsy

No guidelines exist concerning risk factors, diagnosis, management and treatment of stroke-related seizures. Seizures related to intracerebral haemorrhages occur in 10.6%, while those related to ischaemic stroke appear in 8.6%. Early-onset seizures have a poor prognosis with a high in-hospital mortality rate. They occur significantly more often in patients with haemorrhagic strokes. The recurrence rate is low. Late-onset seizures occur mainly between 6 months and 2 years after stroke with a high recurrence rate. Patients with a partial anterior circulation syndrome, a large cortical infarct with irregular borders, located in the parieto-temporal regions, are mainly at risk. Post-stroke seizures are harmful and require treatment with antiepileptic drugs. Post-stroke EEG can help to predict those patients who are at risk of developing seizures. The difference between early- and late-onset seizures is arbitrary as 20% of seizures occurring in patients with a previous cerebral infarct are the clinical expression of a new stroke.