Chapter 34 - Seizures after stroke

Abstract

Especially in the elderly population, stroke is the most common cause of seizures and epilepsy. Seizures following stroke occur in about 10% of patients overall, especially in the first few weeks. Acute or remote stroke is the most common etiology of status epilepticus in the elderly. Seizures are more common after cerebral hemorrhage than after infarction. There have been many epidemiological studies conducted on seizures and epilepsy after stroke, often with different results. This relates to heterogeneous study design, differences in terminology and definitions, study setting, and variable periods of follow-up. Although stroke is one of the leading brain injuries that causes acquired epilepsy, little is known concerning the molecular mechanisms underlying stroke-induced epileptogenesis. Further studies are needed for understanding the mechanism of early- and late-onset seizures after stroke. Treatment strategies must allow for complexities of comorbidity, comedication, as well as pharmacokinetic and pharmacodynamic alterations in the elderly. A better understanding of the role of anticonvulsant therapy in the management and prophylaxis of poststroke seizures and epilepsy is required to provide guidelines for management. Further studies in this area are still needed to establish optimal treatment strategies. As the proportion of older people in the population grows, as well as the prevalence and incidence of stroke, the management of seizures and epilepsy in this population will become increasingly important.