Published Online
on May 27, 2004

A more recent version of this article appeared on July 1, 2004

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Submitted on December 16, 2003
Revised on February 20, 2004
Accepted on March 5, 2004

Seizures and Epilepsy After Ischemic Stroke

Osvaldo Camilo MD and Larry B. Goldstein MD^*

From the Department of Medicine (Neurology) (O.C., L.B.G.), the Duke Center for Cerebrovascular Disease (O.C., L.B.G.), and the Stroke Policy Program (O.C.), Center for Clinical Health Policy Research, Duke University, Durham, NC; and the Durham VA Medical Center (O.C.), Durham, NC.

^* To whom correspondence should be addressed. E-mail: golds004{at}mc.duke.edu.

Background--Although a long recognized clinical phenomenon, there remain many questions regarding the epidemiology of seizures and epilepsy after ischemic stroke, their effect on outcome, and their treatment.

Summary of Review--Interpretation of the various studies that have been conducted of postischemic stroke seizures and epilepsy are complicated by their heterogeneous designs, inconsistent uses of terminology, small sample sizes, different periods of follow-up, and ambiguities in seizure identification and classification. Estimates of the rate of early postischemic stroke seizures range from 2% to 33%. The rates of late seizures vary from 3% to 67%. The rate of postischemic stroke epilepsy is 2% to 4% and is higher in those who have a late seizure. Data reflecting seizure subtypes are limited. Aside from cortical location and, possibly, stroke severity, no other risk factors for postischemic stroke seizures have been consistently demonstrated. Results regarding the impact of postischemic stroke seizures on outcome are inconsistent.

Conclusions--Much additional work is needed to better understand the epidemiology and social impact of postischemic stroke seizures and epilepsy, their prevention, and optimal management.

Key words: epilepsy • ischemia • seizures • stroke

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