Management of stroke-related seizures

Although general guidelines exist for the diagnosis and the treatment of epilepsy, no specific recommendations are available concerning the management of seizures related to cerebrovascular disease. The incidence of seizures after stroke was found to be 8.9% in the only published prospective study. This is an underestimation as seizures occurring at stroke onset were not taken in to account and non-convulsive spells are rarely recognized as such. Risk factors, diagnosis, management and treatment will be different according to the time of onset of the seizures in relation to the stroke. As, on one hand, repeated seizures and status epilepticus worsen the neurological and the mental condition of stroke patients and, on the other hand, antiepileptic drugs (AEDs) can also increase cognitive impairment, the main questions to be answered are for which patients AEDs should be prescribed and which drug should be preferred.