Vascular Epilepsy
Abstract
Oumerzouk J and Oumerzouk Jawad
Seizures can be a presenting feature of acute stroke. They may complicate its early clinical course or be a late complication or sequel. The incidence of combined “early” and “late” seizures after stroke has been reported to be approximately 10% and the prevalence is of 2-4%. Mechanisms leading to post stroke seizures and chronic epilepsy, in both ischemic and hemorrhagic strokes, are diverse. Focal slowing or diffuse slowing activities, rhythmic slow waves are associated with a low risk of early onset seizures whereas focal spikes, sharp waves, periodic lateralized, or periodic bilateral discharges are associated with a higher risk.
There are no randomised controlled trials performed in stroke patients evaluating management strategies for poststroke seizures and epilepsy. Treatment options should be extrapolated from those of epilepsy in general, taking into consideration hepatic and renal function, tolerability, costs, interactions between antiepileptic drugs (AED), interactions with antithrombotic and other treatments. However, randomised controlled trials of AED prophylaxis for acute and remote seizures are essential to improve the evidence level of current guidelines and recommendations for the management of post-stroke seizures