Epileptic Disorders


How to diagnose and treat post-stroke seizures and epilepsy Volume 22, numéro 3, June 2020


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1 Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
2 Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
3 Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
4 Radiology Unit, Hospital of Rovereto, Trento, Italy
5 Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
6 Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Affiliated partner ERN EpiCARE, Salzburg, Austria
7 Center for Cognitive Neuroscience, Salzburg, Austria
8 Public Health, Health Services Research and HTA, University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
9 Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
* Correspondence

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Stroke is one of the commonest causes of seizures and epilepsy, mainly among the elderly and adults. This seminar paper aims to provide an updated overview of post-stroke seizures and post-stroke epilepsy (PSE) and offers clinical guidance to anyone involved in the treatment of patients with seizures and stroke. The distinction between acute symptomatic seizures occurring within seven days from stroke (early seizures) and unprovoked seizures occurring afterwards (late seizures) is crucial regarding their different risks of recurrence. A single late post-stroke seizure carries a risk of recurrence as high as 71.5% (95% confidence interval: 59.7-81.9) at ten years and is diagnostic of PSE. Several clinical and stroke characteristics are associated with increased risk of post-stroke seizures and PSE. So far, there is no evidence supporting the administration of antiepileptic drugs as primary prevention, and evidence regarding their use in PSE is scarce.