Post-Stroke Seizures and Epilepsy Management

Seizures occurring after stroke are broadly categorised as early (within seven days) or late (beyond seven days), the latter defining post-stroke epilepsy. Early seizures arise from acute metabolic and ionic disturbances, whereas late seizures reflect permanent structural reorganisation and maladaptive plasticity in cortical networks. Incidence varies with stroke subtype and severity, ranging from around 3% for acute symptomatic events to 10–15% for remote seizures, with haemorrhagic strokes and cortical involvement carrying the highest risk. Key clinical predictors include admission stroke severity (as measured by the NIH Stroke Scale), lesion size and location, age and concurrent infections. Emerging risk models combine clinical scores and machine-learning techniques to stratify individuals at greatest risk. Management demands a clear distinction between acute symptomatic and unprovoked seizures: short-term antiseizure therapy is often adequate for early events, whereas remote seizures warrant long-term treatment. Choice of antiseizure medication balances efficacy, tolerability and interactions with antithrombotic regimens. Multidisciplinary pathways and individualised risk assessment underpin optimal outcomes and resource allocation worldwide.

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Post-Stroke Seizures and Epilepsy Management publication trend

The graph below shows the total number of articles in post-stroke seizures and epilepsy management across all publications each year (not limited to Nature Index journals).

Technical terms

Early symptomatic seizure: A seizure occurring within seven days of stroke onset, driven by acute biochemical and ionic imbalances.

Late seizure: A seizure occurring one week or more after stroke, indicative of permanent structural changes and epileptogenesis.

NIH Stroke Scale (NIHSS): A standardised tool to assess neurological deficit severity after stroke.

Antiseizure medication (ASM): Pharmacological agents used to prevent or control epileptic seizures.

Area under the curve (AUC): A measure of predictive model performance, indicating discrimination between outcomes.

References

1. Predictive models for secondary epilepsy in patients with acute ischemic stroke within one year. eLife (2024).
2. Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study. Annals of Intensive Care (2023).
3. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management. Drugs & Aging (2021).
4. Post Stroke Seizures and Epilepsy: From Proteases to Maladaptive Plasticity. Frontiers in Cellular Neuroscience (2019).
5. Post-stroke seizure and post-stroke epilepsy. Postgraduate Medical Journal (2006).