Epileptogenesis and risk factors of symptomatic epileptic seizures in patients with acute cerebrovascular accidents

Epileptic seizures are defined as transient, abnormal, excessive synchronous activity of neurons in the brain, which can be provoked or unprovoked. While unprovoked seizures are common in many idiopathic epilepsies, provoked seizures are usually caused by acute or chronic CNS conditions. These often include cerebrovascular diseases such as ischemic stroke, intracerebral and subdural hemorrhages, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis. Of note, other less common processes that can provoke seizures include CNS infections, inflammation, systemic metabolic disorders (hypo/hyperglycemia, hypo/hypernatremia, hypocalcemia), alcohol poisoning, as well as alcohol, benzodiazepine, and barbiturate withdrawal. Stroke is a major cause of seizures and epilepsy in older adults. Seizures shortly after a stroke can lead to increased oxidative stress and cell death, causing an extension of the infarction zone, mortality, and adverse functional outcomes. In this review, we describe the epidemiology, risk factors, biomarkers, and treatment of symptomatic seizures in patients with cerebrovascular accidents.