Medical Management of Seizures in Cerebrovascular Disorders

Abstract

Cerebrovascular disorders are one of the most common identifiable causes of epilepsy, especially in the elderly [1]. Seizures after a stroke can occur early, within 7-14 days [2-6], or late, after 14 days [7][8][9][10]. Early seizures do not necessarily progress to epilepsy, but may result in increased morbidity and mortality. Reports vary considerably regarding the incidence of single seizures and epilepsy after a stroke. In adults younger than 50 years of age, 12.7 % with ischemic strokes and 25.6 % with intracranial hemorrhage developed epilepsy. This study used the more recent definition of epilepsy, which is the occurrence of a single seizure associated with an enduring condition associated with epilepsy. Another large study reported the occurrence of seizures in 168 (8.9 %) of 1897 persons following an ischemic stroke and 28 (10.6 %) of 265 after a hemorrhagic stroke [4]. Most seizures occurred within 2 years of the stroke.A critical question addressing the issue of treatment is the occurrence of a second seizure after a single seizure. Unfortunately, this is a difficult question to answer from the literature. Many physicians initiate treatment with antiepileptic drugs (AEDs) following a single seizure because of the perception that there is a high risk of additional seizures in the context of stroke and seizure. Thus, reports of recurrent seizures are confounded with treatment, and it is difficult to establish the risk of epilepsy as defined by two or more unprovoked seizures. In one study by Arntz, 75 % of persons with an ischemic stroke and 80 % with a hemorrhagic stroke were