[Epileptic seizures in patients with a cerebrovascular infarction]

In view of the possible occurrence of epileptic manifestations and possible factors predisposing to them, the clinical course of 90 cerebral infarct patients was studied retrospectively and prospectively in a medical rehabilitation department for an average of 29 1/2 months. The following results were obtained: "prodromal" seizures (i.e. those preceding a cerebral insult) were not detectable in any of the study patients. 25 patients (27.7%) suffered epileptic seizures, 1 (1.1%) in the acute insult phase only, 2 (2.2%) in this as well as in the later phase, and 22 (24.4%) in the late phase only. All seizures in the acute insult phase were focal-motor or secondary generalized. Among all 24 patients (26.6%), the latency of late epileptic manifestations ranged from 2 1/2 months to 3 3/4 years and averaged about 12 months. Patients with cortical or cortical-subcortical brain lesions suffered epileptic seizures-as reported in the literature-significantly more frequently than those with exclusively subcortical insults. Based on the features of the focal (motor or psychomotor) seizures and/or interictal focal EEG spikes, there was clear evidence of a focus giving rise to epileptic discharges in the insulted hemisphere in 75% of the patients with late seizures. Under antiepileptic therapy (chiefly with phenytoin), the seizure frequency was slight (not exceeding 2 per year in 3/4 of the patients).