How to diagnose and treat post‐stroke seizures and epilepsy

Stroke is one of the commonest causes of seizures and epilepsy, mainly among the elderly and adults. This seminar paper aims to provide an updated overview of post‐stroke seizures and post‐stroke epilepsy (PSE) and offers clinical guidance to anyone involved in the treatment of patients with seizures and stroke. The distinction between acute symptomatic seizures occurring within seven days from stroke (early seizures) and unprovoked seizures occurring afterwards (late seizures) is crucial regarding their different risks of recurrence. A single late post‐stroke seizure carries a risk of recurrence as high as 71.5% (95% confidence interval: 59.7–81.9) at ten years and is diagnostic of PSE. Several clinical and stroke characteristics are associated with increased risk of post‐stroke seizures and PSE. So far, there is no evidence supporting the administration of antiepileptic drugs as primary prevention, and evidence regarding their use in PSE is scarce.