Seizures and stroke

Christopher F. Bladin, Geoffrey A. Donnan

Research output: Chapter in Book/Report/Conference proceedingChapter (Book)Otherpeer-review

Abstract

Introduction Stroke has long been recognized as one of the most common causes of epileptic seizures, particularly in older people [1]. Stroke accounts for 30% of newly diagnosed seizures in patients over 60 years of age [2], and is the most commonly identified etiology of secondary epilepsy [3]. The results of epidemiological studies on seizures and epilepsy after stroke have been variable due to heterogeneous study design, study setting (hospital versus community), period of follow-up, small sample sizes, and inconsistencies in seizure identification and classification. The evidence base for the pharmacological management of poststroke seizures (PSS) and poststroke epilepsy (PSE) is limited, which is a particular issue for older people who are more prone to therapy-related side effects and drug interactions, and are often excluded from clinical trials. The long-term medical, neuropsychological, and social impacts of PSS and PSE are poorly understood. This chapter will provide an overview of the various epidemiological studies on PSS and PSE, and will attempt to give an understanding of their pathogenesis, outcome, and management. Terminology, timing, and frequency of poststroke seizures Reports on the frequency of seizures following stroke vary quite widely because of differing stroke patient populations, sample sizes studied, follow-up periods, definitions used for stroke and seizures, and use of neuroimaging (CT/MRI). In most studies, the follow-up period was less than a few weeks, so documentation of late-onset seizures, or recurrent seizures (PSE), is often limited. Poststroke seizures are usually classified as either early-onset or late-onset seizures. Early seizures have been defined as the first seizure occurring within 48 hours [4â€6], seven days [7], two weeks [8â€10], or one month [11] of stroke onset. The International League Against Epilepsy criteria (ILAE) [12], defines early seizures as those that occur within seven days of stroke onset, and late seizures those that develop beyond one week. Poststroke epilepsy has been defined as recurrent epileptic seizures after stroke, requiring the use of antiepileptic prophylaxis [13] after exclusion of other possible causes of seizures.

Original languageEnglish
Title of host publicationStroke Syndromes: Third Edition
EditorsLouis R. Caplan, Jan van Gijn
Place of PublicationCambridge UK
PublisherCambridge University Press
Pages158-165
Number of pages8
ISBN (Electronic)9781139093286
ISBN (Print)9781107018860
DOIs
Publication statusPublished - 1 Jan 2012

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