Skip to main content
SpringerLink
Log in
Book cover

Seizures in Cerebrovascular Disorders pp 17–29Cite as

Seizures in Ischemic Stroke

  • Chapter
  • First Online:

Abstract

Cerebrovascular disease is the most commonly identified antecedent for adult epilepsy, accounting for 11 % of cases. Stroke is associated with a 23–35-fold increase in the incidence of seizure, and a 17-fold higher risk for the development of epilepsy. Epilepsy following ischemic stroke may occur early or late during the disease process. The functional impact, underlying mechanism, and epilepsy risk of late seizures may be different than early seizures. Approximately, 3–5 % of stroke survivors experience a late seizure within a year of their first episode, with 54–66 % of these patients going on to develop epilepsy. Various types of seizures have been reported with ischemic stroke including status epilepticus. Conversely, various types of ischemic stroke have been associated with epilepsy, especially the cardioembolic and cortical strokes. Acute ischemic stroke may have a number of electroencephalography (EEG) patterns, of which periodic lateralized epileptiform discharges are of particular significance. Some authors have favored initiating antiepileptic drugs (AEDs) after an early poststroke seizure, while others have recommended treatment after a late seizure. Late seizures carry higher risk of recurrence, and thus, AED therapy is recommended. Newer-generation AEDs do not demonstrate significant interactions with warfarin or antiplatelet agents, and they are less impactful on the recovery process after stroke.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in rochester, minnesota: 1935–1984. Epilepsia. 1993;34:453–68.

    Article  CAS  PubMed  Google Scholar 

  2. So EL, Annegers JF, Hauser WA, O’Brien PC, Whisnant JP. Population-based study of seizure disorders after cerebral infarction. Neurology. 1996;46:350–5.

    Article  CAS  PubMed  Google Scholar 

  3. Ryvlin P, Montavont A, Nighoghossian N. Optimizing therapy of seizures in stroke patients. Neurology. 2006;67:S3–9.

    Article  PubMed  Google Scholar 

  4. Forsgren L, Bucht G, Eriksson S, Bergmark L. Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia. 1996;37:224–9.

    Article  CAS  PubMed  Google Scholar 

  5. Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. Br Med J. 1997;315:1582–7.

    Article  CAS  Google Scholar 

  6. Bleck TP. Seven questions about stroke and epilepsy. Epilepsy Curr. 2012;12:225–8.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Labovitz DL, Hauser WA, Sacco RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology. 2001;57:200–6.

    Article  CAS  PubMed  Google Scholar 

  8. Reith J, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Seizures in acute stroke: predictors and prognostic significance. The copenhagen stroke study. Stroke. 1997;28:1585–9.

    Article  CAS  PubMed  Google Scholar 

  9. Afsar N, Kaya D, Aktan S, Sykut-Bingol C. Stroke and status epilepticus: stroke type, type of status epilepticus, and prognosis. Seizure. 2003;12:23–7.

    Article  PubMed  Google Scholar 

  10. Moskowitz E, Lightbody FE, Freitag NS. Long-term follow-up of the poststroke patient. Arch Phys Med Rehabil. 1972;53:167–72.

    CAS  PubMed  Google Scholar 

  11. Arboix A, Comes E, Massons J, Garcia L, Oliveres M. Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease. Neurology. 1996;47:1429–35.

    Article  CAS  PubMed  Google Scholar 

  12. Heuts-van Raak L, Lodder J, Kessels F. Late seizures following a first symptomatic brain infarct are related to large infarcts involving the posterior area around the lateral sulcus. Seizure. 1996;5:185–94.

    Google Scholar 

  13. Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Cote R, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000;57:1617–22.

    Article  CAS  PubMed  Google Scholar 

  14. Bentes C, Pimentel J, Ferro JM. Epileptic seizures following subcortical infarcts. Cerebrovasc Dis. 2001;12:331–4.

    Article  CAS  PubMed  Google Scholar 

  15. Camilo O, Goldstein LB. Seizures and epilepsy after ischemic stroke. Stroke. 2004;35:1769–75.

    Article  PubMed  Google Scholar 

  16. Saposnik G, Caplan LR. Convulsive-like movements in brainstem stroke. Arch Neurol. 2001;58:654–7.

    Article  CAS  PubMed  Google Scholar 

  17. Ghika J, Bogousslavsky J, van Melle G, Regli F. Hyperkinetic motor behaviors contralateral to hemiplegia in acute stroke. Eur Neurol. 1995;35:27–32.

    Article  CAS  PubMed  Google Scholar 

  18. Kim JS. Involuntary movements after anterior cerebral artery territory infarction. Stroke. 2001;32:258–61.

    Article  CAS  PubMed  Google Scholar 

  19. Fisher CM. Concerning recurrent transient cerebral ischemic attacks. Can Med Assoc J. 1962;86:1091–9.

    PubMed Central  CAS  PubMed  Google Scholar 

  20. Siniscalchi A, Gallelli L, Malferrari G, De Sarro G. Limb-shaking transient ischemic attack associated with focal electroencephalography slowing: case report. J Vasc Interv Neurol. 2012;5:3–5.

    PubMed Central  PubMed  Google Scholar 

  21. Yanagihara T, Piepgras DG, Klass DW. Repetitive involuntary movement associated with episodic cerebral ischemia. Ann Neurol. 1985;18:244–50.

    Article  CAS  PubMed  Google Scholar 

  22. Levine RL, Lagreze HL, Dobkin JA, Hanson JM, Satter MR, Rowe BR, et al. Cerebral vasocapacitance and tias. Neurology. 1989;39:25–9.

    Article  CAS  PubMed  Google Scholar 

  23. Knoflach M, Matosevic B, Meinhart M, Rucker M, Furtner M, Zangerle A, et al. Prognostic relevance of limb shaking in symptomatic carotid artery occlusion. Cerebrovasc Dis. 2011;32:35–40.

    Article  PubMed  Google Scholar 

  24. Ropper AH, Adams RD, Victor M, Brown RH, Victor M. Adams and victor's principles of neurology. New York: McGraw-Hill Medical; 2005.

    Google Scholar 

  25. Lamy C, Domigo V, Semah F, Arquizan C, Trystram D, Coste J, et al. Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology. 2003;60:400–4.

    Article  CAS  PubMed  Google Scholar 

  26. Denier C, Masnou P, Mapoure Y, Souillard-Scemama R, Guedj T, Theaudin M, et al. Watershed infarctions are more prone than other cortical infarcts to cause early-onset seizures. Arch Neurol. 2010;67:1219–23.

    Article  PubMed  Google Scholar 

  27. Beghi E, D’Alessandro R, Beretta S, Consoli D, Crespi V, Delaj L, et al. Incidence and predictors of acute symptomatic seizures after stroke. Neurology. 2011;77:1785–93.

    Article  CAS  PubMed  Google Scholar 

  28. Abou-Chebl A, Yadav JS, Reginelli JP, Bajzer C, Bhatt D, Krieger DW. Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting: risk factors, prevention, and treatment. J Am Coll Cardiol. 2004;43:1596–601.

    Article  PubMed  Google Scholar 

  29. Solomon RA, Loftus CM, Quest DO, Correll JW. Incidence and etiology of intracerebral hemorrhage following carotid endarterectomy. J Neurosurg. 1986;64:29–34.

    Article  CAS  PubMed  Google Scholar 

  30. Lynch MW, Rutecki PA, Sutula TP. The effects of seizures on the brain. Curr Opin Neurol. 1996;9:97–102.

    Article  CAS  PubMed  Google Scholar 

  31. Burneo JG, Fang J, Saposnik G. Impact of seizures on morbidity and mortality after stroke: a canadian multi-centre cohort study. Eur J Neurol. 2010;17:52–8.

    Article  CAS  PubMed  Google Scholar 

  32. Masterson K, Vargas MI, Delavelle J. Postictal deficit mimicking stroke: role of perfusion ct. J Neuroradiol [Journal de neuroradiologie]. 2009;36:48–51.

    Article  CAS  Google Scholar 

  33. Winkler DT, Fluri F, Fuhr P, Wetzel SG, Lyrer PA, Ruegg S, et al. Thrombolysis in stroke mimics: frequency, clinical characteristics, and outcome. Stroke. 2009;40:1522–5.

    Article  PubMed  Google Scholar 

  34. Morimoto E, Kanagaki M, Okada T, Yamamoto A, Mori N, Matsumoto R, et al. Anterior temporal lobe white matter abnormal signal (atlas) as an indicator of seizure focus laterality in temporal lobe epilepsy: comparison of double inversion recovery, FLAIR and T2W MR imaging. Eur Radiol. 2013;23:3–11.

    Article  PubMed  Google Scholar 

  35. Consoli D, Bosco D, Postorino P, Galati F, Plastino M, Perticoni GF, et al. Levetiracetam versus carbamazepine in patients with late poststroke seizures: a multicenter prospective randomized open-label study (epic project). Cerebrovasc Dis. 2012;34:282–9.

    Article  CAS  PubMed  Google Scholar 

  36. Sinha S, Satishchandra P, Kalband BR, Bharath RD, Thennarasu K. Neuroimaging observations in a cohort of elderly manifesting with new onset seizures: experience from a university hospital. Ann Indian Acad Neurol. 2012;15:273–80.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Mathews MS, Smith WS, Wintermark M, Dillon WP, Binder DK. Local cortical hypoperfusion imaged with ct perfusion during postictal todd's paresis. Neuroradiology. 2008;50:397–401.

    Article  PubMed  Google Scholar 

  38. Kalamangalam GP, Diehl B, Burgess RC. Neuroimaging and neurophysiology of periodic lateralized epileptiform discharges: observations and hypotheses. Epilepsia. 2007;48:1396–405.

    Article  PubMed  Google Scholar 

  39. Mecarelli O, Pro S, Randi F, Dispenza S, Correnti A, Pulitano P, et al. EEG patterns and epileptic seizures in acute phase stroke. Cerebrovasc Dis. 2011;31:191–8.

    Article  CAS  PubMed  Google Scholar 

  40. Myint PK, Staufenberg EF, Sabanathan K. Post-stroke seizure and post-stroke epilepsy. Postgrad Med J. 2006;82:568–72.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Jordan KG. Emergency EEG and continuous EEG monitoring in acute ischemic stroke. J Clin Neurophysiol. 2004;21:341–52.

    PubMed  Google Scholar 

  42. Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology. 1991;41:965–72.

    Article  CAS  PubMed  Google Scholar 

  43. Ryvlin P. When to start antiepileptic drug treatment: seize twice might not harm. Current Opin Neurol. 2006;19:154–6.

    Article  Google Scholar 

  44. Beghi E, De Maria G, Gobbi G, Veneselli E. Diagnosis and treatment of the first epileptic seizure: guidelines of the Italian league against epilepsy. Epilepsia. 2006;47 Suppl 5:2–8.

    Article  CAS  PubMed  Google Scholar 

  45. Labovitz DL, Hauser WA. Preventing stroke-related seizures: when should anticonvulsant drugs be started? Neurology. 2003;60:365–6.

    Article  PubMed  Google Scholar 

  46. Gilad R, Sadeh M, Rapoport A, Dabby R, Boaz M, Lampl Y. Monotherapy of lamotrigine versus carbamazepine in patients with poststroke seizure. Clin Neuropharmacol. 2007;30:189–95.

    CAS  PubMed  Google Scholar 

  47. Goldstein LB. Potential effects of common drugs on stroke recovery. Arch Neurol. 1998;55:454–6.

    Article  CAS  PubMed  Google Scholar 

  48. Alvarez-Sabin J, Montaner J, Padro L, Molina CA, Rovira R, Codina A, et al. Gabapentin in late-onset poststroke seizures. Neurology. 2002;59:1991–3.

    Article  CAS  PubMed  Google Scholar 

  49. Szaflarski JP, Rackley AY, Kleindorfer DO, Khoury J, Woo D, Miller R, et al. Incidence of seizures in the acute phase of stroke: a population-based study. Epilepsia. 2008;49:974–81.

    Article  PubMed  Google Scholar 

  50. Paolucci S, Silvestri G, Lubich S, Pratesi L, Traballesi M, Gigli GL. Poststroke late seizures and their role in rehabilitation of inpatients. Epilepsia. 1997;38:266–70.

    Article  CAS  PubMed  Google Scholar 

  51. Waterhouse EJ, Vaughan JK, Barnes TY, Boggs JG, Towne AR, Kopec-Garnett L, et al. Synergistic effect of status epilepticus and ischemic brain injury on mortality. Epilepsy Res. 1998;29:175–83.

    Article  CAS  PubMed  Google Scholar 

  52. Velioglu SK, Ozmenoglu M, Boz C, Alioglu Z. Status epilepticus after stroke. Stroke. 2001;32:1169–72.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Interventional Neuroradiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA

    Benny S. Kim MD

  2. Department of Neurology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Cathy Sila MD

Authors
  1. Benny S. Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cathy Sila MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benny S. Kim MD .

Editor information

Editors and Affiliations

  1. Department of Neurology Director, Epilepsy Center, George Washington University, Washington DC, District of Columbia, USA

    Mohamad Z. Koubeissi

  2. SSM-Neurosciences Institute and St. Louis University, St. Louis University, Missouri, Missouri, USA

    Amer Alshekhlee

  3. Vascular Neurology Fellow, University of Virginia, Charlottesville, Virginia, Virginia, USA

    Prachi Mehndiratta

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kim, B., Sila, C. (2015). Seizures in Ischemic Stroke. In: Koubeissi, M., Alshekhlee, A., Mehndiratta, P. (eds) Seizures in Cerebrovascular Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2559-9_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-2559-9_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2558-2

  • Online ISBN: 978-1-4939-2559-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation