Poststroke epilepsy: update and future directions

Abstract

Stroke is among the most common causes of epilepsy after middle age. Patients with poststroke epilepsy (PSE) differ in several respects from patients with other forms of structural-metabolic epilepsy; not least in age, age-related sensitivity to side effects of antiepileptic drugs (AEDs), and specific drug-drug interaction issues related to secondarystroke prophylaxis. Encouragingly, there has lately been remarkable activity in the study of PSE. Three developments in PSE research deserve particular focus. First, large prospective trials have established the incidence and risk factors of PSE in the setting of modern stroke care. Stroke severity, cortical location, young age, and haemorrhage remain the most important risk factors. Second, although more studies are needed, epidemiological data indicate that the risk of PSE may be influenced, for instance, by statin treatment. Third, studies are emerging regarding the treatment and prognosis of PSE. Levetiracetam and lamotrigine may be well tolerated treatment options and seizure freedom is achieved in at least a similar proportion of patients as in other epilepsies. Furthermore, new animal models such as photothrombotic stroke gives hope of a more clear understanding of PSE epileptogenesis in the near future. In summary, PSE shows indications of maturing into an independent epilepsy research field. This review summarizes recent advances in our understanding of PSE and provides an update on management issues such as diagnosis, AED selection, and prognosis. Finally, future research challenges in the field are outlined.

The impact of large structural brain changes in chronic stroke patients on the electric field caused by transcranial brain stimulation

“…However, additional factors such as a generally higher risk for seizures after stroke (Zelano, 2016) exist, which might, for example, decrease the threshold for seizure-induction by repetitive TMS protocols. While our findings are encouraging, they should thus be interpreted with some caution.…”

Retention rate of first antiepileptic drug in poststroke epilepsy: A nationwide study

“…Specific evidence to guide treatment of PSE is surprisingly scarce. Carbamazepine has been a traditional choice in focal epilepsy, but concerns that elderly patients may be vulnerable to side effects, and that induction of liver enzymes may interfere with secondary stroke prophylaxis, has led to an interest in other AEDs in PSE [5,6]. Two small, open-label RCTs have demonstrated better short-term tolerability of lamotrigine and levetiracetam than slow-release carbamazepine in patients with PSE [7,8].…”

Effect of single‐session transcranial direct current stimulation on cognition in Parkinson's disease

“…The task required subjects to press a button as fast as they could but to ensure accuracy when a displayed facial expression matched the preceding cue (Go cues) and to withhold pressing when the expression did not match the cue (Nogo cues). The set of stimuli included five facial expressions (happy, sad, fearful, angry, and neutral) of 10 adults (5 males and 5 females) …”

“…The set of stimuli included five facial expressions (happy, sad, fearful, angry, and neutral) of 10 adults (5 males and 5 females). 10 Each trial began with a central fixation cross that appeared for 500 ms, followed by a randomly assigned cue (one of the five expressions, eg "Happy") presented for 1000 ms, as the Go stimulus such that the remaining expressions (sad, fearful, angry, and neutral in this example) would be the Nogo stimuli. The Go stimuli comprised of 70% of each block to create a tendency for the subjects to respond.…”