Poststroke Seizure Care Differs with Time of Occurrence

A common complication of stroke, poststroke seizures require a systematic diagnosis, according to a review article in Frontiers in Neurology.

“It is pivotal to systematically approach, evaluate, classify, and manage them, and differentiate them from abnormal movement disorders, syncope, and psychogenic nonepileptic seizures based on semiology,” wrote a team from the Jeonbuk National University Medical School and Hospital in Jeonju, South Korea.

Additionally, poststroke seizures should be classified as early or late seizures depending on when they occur. The International League Against Epilepsy considers seizures that occur within 7 days of stroke to be early seizures. Poststroke seizures that occur later are considered late seizures.

Early seizures share a clinical course with acute symptomatic seizures and do not typically recur or require long-term antiseizure medication, according to the article. Late seizures, on the other hand, have a recurrence risk similar to unprovoked seizures in patients with focal lesions. Consequently, long-term administration of antiseizure medication is necessary.

“Once a poststroke seizure is confirmed, we can effectively treat patients, improve their prognosis by determining whether it is an early or late seizure, and plan a treatment strategy appropriate for their condition,” the authors explained.

Antiseizure medications such as lamotrigine, carbamazepine, lacosamide, levetiracetam, phenytoin, and valproate may factor into a patient’s treatment plan depending on the timing of stroke and other clinical considerations.

“Stroke incidence has risen over the last few decades,” the authors wrote, “and with post-stroke seizures being a complication with impacts on morbidity, mortality, and treatment, an understanding of the definition, diagnostic evaluation, treatment, and future study directions of post-stroke seizures and epilepsy is warranted.”

Reference

Ryu HU, Kim HJ, Shin BS, Kang HG. Clinical approaches for poststroke seizure: a review. Front Neurol. 2024;15:1337960. doi:10.3389/fneur.2024.1337960