[Poststroke epilepsy: update on diagnosis, treatment and prognosis]

Poststroke epilepsy: update on diagnosis, treatment and prognosis  Recent advances in our understanding of poststroke epilepsy have implications for clinical practice. Epidemiological studies indicate cumulative risks of 5-12%. The main risk factors are large lesions, hemorrhage, cortical lesions, and early seizures. Clinical trials have shown levetiracetam and lamotrigine to be appropriate first-line treatment options, with favorable tolerability and lack of significant interactions with secondary stroke prophylaxis. Seizure freedom is often achieved in prospective trials, but data from routine health care are less impressive. Unfortunately, observational studies suggest that poststroke epilepsy is associated with poor survival. This partly reflects the greater risk of epilepsy seen in severe stroke, but even the influence of epilepsy or antiepileptic drugs on stroke prognosis needs further study. The most current research areas include prevention of seizures and epileptogenesis and the impact of late-onset epilepsy on vascular risk.