Case Report: EEG Picture in a Patient with Post-Stroke Epilepsy

Abstract

Introduction: Epilepsy is a chronic brain disorder that affects people all over the world. Seizures are the most common neurologic symptom in stroke patients. Approximately 10% of all stroke patients have experienced seizures, and post-stroke seizures generally begin several years after the stroke. Case Illustration: A male patient, 55 years old, Balinese, Kinan, came to the emergency room of Prof. Dr. I.G.N.G. Ngoerah General Hospital with complaints of seizures. The first seizure occurred on December 19, 2021, with a pattern of glancing at the left eye then, followed by full-body twitching, which lasted approximately 5 minutes and stopped on its own. The patient said that before the seizure, the patient was well conscious; during the seizure, the patient was unconscious, and after the seizure, the patient regained consciousness as before the seizure. Then, the seizure repeated the next day (December 20, 2021) with the same pattern and duration, but the patient was not taken for treatment. On physical examination, the patient was alert with vital signs and general physical examination within normal limits. Neurologic examination revealed no focal neurologic deficits. Electroencephalography (EEG) examination showed intermittent slow activity in the left and right fronto-centro-occipital areas. Computed tomography scan (CT-Scan) examination of the head without contrast revealed a hypodense image in the right temporo-parietal lobe. The patient then received anti-epileptic drug (OAE) therapy, OAE therapy given Phenytoin 200 mg every 12 hours intra-orally, Folic Acid 1 mg every 24 hours intra-orally, and anti-platelet and anti-hypertension continued. Discussion: Post-stroke seizure (PSS) is an episode of convulsion that occurs either single or multiple after a stroke, which is thought to be due to irreversible or reversible brain damage. At the same time, post-stroke epilepsy is convulsions after a stroke that occur at least two revivals without provocation with a distance between revivals of more than 24 hours. PSS classification is divided into early post-stroke seizure, where seizures occur onset two weeks early post-stroke, and late (delayed) post-stroke seizure if seizures occur onset after two weeks post-stroke. Post-stroke seizures' most common electroencephalography (EEG) waves are generalized slow waves, focal slowing, focal sharp and slow waves, and periodic lateralized epileptiform discharges (PLEDs). However, 5.1% of patients have normal EEG. The administration of anti-convulsants to prevent recurrent seizures is recommended by the European Guidelines of The European Stroke Organization. In comparison, prophylaxis is not recommended for patients with post-stroke. Keywords: Post-stroke Epilepsy, Stroke, Electroencephalography