Post-stroke epilepsy is a complication after stroke. Stroke patients may experience only a single seizure, but may also experience multiple seizures associated with the development of post-stroke epilepsy. In the case of post-stroke epilepsy, it is not uncommon to encounter certain difficulties that may concern, for example, its treatment.

Post-stroke epilepsy( post-stroke epilepsy ) is not a common phenomenon - according to statistics, in the first year after stroke she experiences epileptic seizures up to 5% of all patients, and the risk of their occurrence decreases with the time elapsing after having a stroke.

Strokes are one of the most common causes of epilepsy in patients over 50.

A complication of a stroke may be both a single epileptic seizure and the occurrence of repeated seizures, allowing the diagnosis of post-stroke epilepsy in a given patient.

Not every stroke predisposes to seizures and epilepsy to the same extent - the greatest risk of such pathologies occurs in patients who have had:

  • hemorrhagic stroke
  • stroke involving large areas of the brain
  • and if the cortex itself is damaged.

Post-stroke epilepsy: causes

The exact pathogenesis of post-stroke seizures and epilepsy has not been known so far. However, there are some theories that differ between early and late post-stroke seizures.

Early seizures (i.e. those that appear during a stroke or in the first few days after its occurrence) may be related, among others, to with:

  • neuronal dysfunction associated with the formation of toxic metabolites
  • ischemia and hypoxia
  • disturbances in the content of electrolytes inside the cells (mainly consisting of excess calcium and sodium inside the cells, which change the excitability of neurons).

Post-stroke epileptic seizures most often take the form of focal seizures - this is especially true for seizuresearly.

The theories about these epileptic seizures that occur only after some time (several weeks after a stroke and later) are slightly different.

It is possible to reach them, among other things, as a result of scarring processes within the nervous tissue, which would result in disturbances in the transmission of electrical impulses between individual nerve cells.

Another problem would be the irritating effect of hemosiderin deposits (remaining after a hemorrhagic stroke) on the cells of the nervous system.

Post-stroke epilepsy: symptoms

It is not possible to give one specific type of seizure that will occur in a patient after a stroke - it depends mainly on which part of the brain the stroke will occur in.

  • Seizure - first aid

For this reason, stroke patients may experience various seizures, including sensory seizures (e.g. in the form of numbness) or motor seizures.

  • Seizures: types
  • Status epilepticus
  • Psychogenic pseudo-epileptic seizures

Much rarer, but also seen as post-stroke seizures, are generalized seizures, usually in the form of tonic-clonic seizures.

It is possible for an epileptic seizure to proceed immediately in this form, and for it to be a secondary generalized seizure (this means that the seizure begins with a focal disorder and then becomes a generalized seizure) ).

More about the symptoms of epilepsy:

  • Epilepsy symptoms in children and adults. How to recognize epilepsy?

Post-stroke epilepsy: diagnosis

It should be emphasized that not every patient who experiences an epileptic seizure after a stroke will be diagnosed with post-stroke epilepsy.

This is due to the fact that these seizures may occur once - in the case of early seizures, it may even happen during the stroke, but also in the first few days after the stroke. This seizure may not recur - in such a case, post-stroke epilepsy cannot be diagnosed.

The criteria for classifying post-stroke epilepsy include the fact that the diagnosis requires the confirmation of repeated seizures.

Generally, in the diagnosis of post-stroke epilepsy, similar studies are used as in the case of other types of epilepsy.

Patients can undergo imaging tests (such as computed tomography or magnetic resonance imaging of the head), as well aselectroencephalographic (EEG).

In the diagnosis of the disease, a medical interview is also important, focusing, among others, on around how often and the nature of a patient's seizures occur.

If any seizure occurs after a stroke, the patient should see a doctor.

Ailments that may be associated with a sensory attack (such as, for example, numbness of a part of the body), may also be caused by problems other than an epileptic seizure, such as another stroke or a transient ischemic attack (TIA) .

It should be remembered that post-stroke epilepsy may appear even several years after a stroke. However, if this occurs after a relatively long time (e.g. more than two years after a stroke), then there is a need to rule out other possible causes of epilepsy in the patient.

Post-stroke epilepsy: treatment

A single seizure after a stroke is usually not an indication for the patient's routine use of anti-epileptic drugs.

The situation is different in the case of post-stroke epilepsy, the treatment of which involves the use of antiepileptic agents.

Currently, there are no recommendations as to which specific preparations should be used in the treatment of stroke epilepsy.

Patients are usually treated with one drug, such as carbamazepine or derivatives of valproic acid.

In the treatment of post-stroke epilepsy, the difficulties most often are not related to the management of epileptic seizures, but to completely different phenomena.

This type of epilepsy usually affects older patients who are already using some other medications.

Problems in this case may concern, inter alia, drug interactions - for example, carbamazepine reduces the blood concentration of one of the anticoagulants, warfarin.

There is also the possibility of the reverse relationship, in which the blood-thinning drug acenocoumarol increases blood levels of the anti-epileptic drug phenytoin.

For these reasons, determining the appropriate dosage of various medications in a patient with post-stroke epilepsy is often difficult.

  • Pharmacological and surgical treatment of epilepsy
  • Stimulation of the vagus nerve in the treatment of epilepsy
  • Telemedicine in the treatment of epilepsy

Post-stroke epilepsy: prognosis

The best prognosis is for those patientswho experience a seizure early after having a stroke.

The later a seizure occurs after a stroke, the greater the risk that the patient will develop post-stroke epilepsy.

The good news, however, is that usually post-stroke epilepsy is controlled with anti-epileptic drugs.

More about epilepsy:

  • Epilepsy syndromes: types
  • Childhood epilepsy with absences (pycnolepsy, Friedman syndrome)
  • Roland's Epilepsy
  • West's Epilepsy Syndrome
  • Northern epilepsy
  • Alcoholic epilepsy

Category:

Neurology