Post – Stroke Seizures: A Comprehensive Review of Epidemiology, Pathophysiology, Risk Factors, Clinical Spectrum and Outcomes
Main Article Content
Abstract
Post – stroke seizure (PSS) represent a significant and often notable complication following cerebrovascular damage due to infarct and hemorrhage, that can affect stroke recovery and the long-term prognosis. This review aims to delineate the epidemiology, clinical spectrum, and outcomes of PSS through an extensive analysis of current literature. It is classified into two types based on the onset of occurrence following stroke, early-onset, occurring within the first seven days following stroke, and late-onset, which manifest beyond seven days after stroke. Early seizures have the same clinical course as acute symptomatic seizures, they rarely recur or require long – term antiepileptic drugs (AED’s). Conversely, late seizures are associated with a risk of recurrence similar to that of unprovoked seizures in a patient with a focal lesion, thereby requiring long – term administration of AED’s. The pathophysiology of PSS is multifaceted and involves a complex interplay of acute metabolic disturbances, excitotoxic neurotransmitter release causing neuronal hyperexcitability, and chronic neural network reorganization. Key risk factors include the type, location, and severity of the stroke, with cortical and hemorrhagic strokes being more prone to induce seizures. Clinically, PSS manifests predominantly as focal seizures, with some cases progressing to generalized seizures or status epilepticus. PSS is associated with poorer functional recovery, reduced quality of life, cognitive decline, increased morbidity, and a higher risk of developing epilepsy. Preventing stroke and PSS remains a cornerstone of any strategy to achieve optimal brain health. Early identification and appropriate management of PSS are crucial for minimizing their impact and thereby improving long – term outcomes for stroke survivors. Effective management includes the use of AED’s, secondary prevention strategies, comprehensive rehabilitation, and regular monitoring. Continued research and individualized treatment plans are essential to develop better preventive, diagnostic, and therapeutic strategies for PSS, ultimately enhancing the prognosis and wellbeing of those affected by strokes.
Keywords:
post-stroke seizure, complication, stroke, morbidity, epilepsy, anti-epileptic drugs
Article Details
How to Cite
RAVIKUMAR, Aparajit et al.
Post – Stroke Seizures: A Comprehensive Review of Epidemiology, Pathophysiology, Risk Factors, Clinical Spectrum and Outcomes.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5768>. Date accessed: 15 nov. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5768.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259-e281.
4. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022 [published correction appears in Int J Stroke. 2022 Apr;17(4):478. doi: 10.1177/1747493 0221080343]. Int J Stroke. 2022;17(1):18-29.
5. Pitkänen A, Roivainen R, Lukasiuk K. Development of epilepsy after ischaemic stroke. Lancet Neurol. 2016;15(2):185-197.
6. Sarecka-Hujar B, Kopyta I. Poststroke epilepsy: current perspectives on diagnosis and treatment. Neuropsychiatr Dis Treat. 2018;15:95-103. Published 2018 Dec 24.
7. Brondani R, de Almeida AG, Cherubini PA, et al. Risk Factors for Epilepsy After Thrombolysis for Ischemic Stroke: A Cohort Study. Front Neurol. 2020;10:1256. Published 2020 Jan 23.
8. Jung S, Schindler K, Findling O, et al. Adverse effect of early epileptic seizures in patients receiving endovascular therapy for acute stroke. Stroke. 2012;43(6):1584-1590.
9. Baranowski CJ. The quality of life of older adults with epilepsy: A systematic review. Seizure. 2018; 60:190-197.
10. Verducci C, Hussain F, Donner E, et al. SUDEP in the North American SUDEP Registry: The full spectrum of epilepsies. Neurology. 2019;93(3): e227-e236.
11. Mauritz M, Hirsch LJ, Camfield P, et al. Acute symptomatic seizures: an educational, evidence-based review. Epileptic Disord. 2022;24(1):26-49.
12. Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia. 1993;34(4):592-596.
13. Feyissa AM, Hasan TF, Meschia JF. Stroke-related epilepsy. Eur J Neurol. 2019;26(1):18-e3.
14. Karhunen H, Jolkkonen J, Sivenius J, Pitkänen A. Epileptogenesis after experimental focal cerebral ischemia. Neurochem Res. 2005;30(12):1529-1542.
15. Hameed, Sajid; Hakeem, Haris; and Wasay, Mohammad (2019) "Post-stroke seizures: a clinically oriented Analysis," Pakistan Journal of Neurological Sciences (PJNS): Vol. 14: Iss. 3, Article 6.
16. Xu MY. Poststroke seizure: optimising its management. Stroke Vasc Neurol. 2018;4(1):48-56. Published 2018 Dec 9.
17. Hesdorffer DC, Benn EK, Cascino GD, Hauser WA. Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure. Epilepsia. 2009;50(5):1102-1108.
18. Alberti A, Paciaroni M, Caso V, Venti M, Palmerini F, Agnelli G. Early seizures in patients with acute stroke: frequency, predictive factors, and effect on clinical outcome. Vasc Health Risk Manag. 2008;4(3):715-720.
19. Lee JC, Lin KL, Wang HS, et al. Seizures in childhood ischemic stroke in Taiwan. Brain Dev. 2009;31(4):294-299.
20. Béjot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. Presse Med. 2016;45(12 Pt 2):e391-e398.
21. Forsgren L, Beghi E, Oun A, Sillanpää M. The epidemiology of epilepsy in Europe - a systematic review. Eur J Neurol. 2005;12(4):245-253.
22. Graham NS, Crichton S, Koutroumanidis M, Wolfe CD, Rudd AG. Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register. Stroke. 2013;44(3):605-611.
23. Zelano J. Poststroke epilepsy: update and future directions. Ther Adv Neurol Disord. 2016;9 (5):424-435.
24. Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. BMJ. 1997;315(7122):1582-1587.
25. Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000;57(11):1617-1622.
26. So EL, Annegers JF, Hauser WA, O'Brien PC, Whisnant JP. Population-based study of seizure disorders after cerebral infarction. Neurology. 1996;46(2):350-355.
27. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8 (4):355-369.
28. Hsu CJ, Weng WC, Peng SS, Lee WT. Early-onset seizures are correlated with late-onset seizures in children with arterial ischemic stroke. Stroke. 2014;45(4):1161-1163.
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