Risk Evaluation and Management of Post-Stroke Epilepsy

Seizure is an important complication following ischemic or hemorrhagic stroke in older adults. Post-stroke seizure can be classified as early or late according to the onset time after stroke. There is a 71% risk for further seizures after a late unprovoked poststroke seizure, which is referred to as poststroke epilepsy. Common risk factors for developing poststroke epilepsy include stroke severity, cortical involvement, and an early poststroke seizure. The use of anti-seizure medication is not recommended for early poststroke seizures due to the low risk of seizure recurrence. However, new-generation anti-seizure medications, including levetiracetam and lamotrigine, are recommended for patients with poststroke epilepsy. Generally, the management of poststroke epilepsy requires consideration of the patient’s age, drug-drug interactions, and vascular prophylaxis.