Are your doctors and hospital ready to prevent these complications? Ask them now before you need it. They've had plenty of time to prepare for it. And make sure they have also considered preventing Parkinsons post stroke.
Epilepsy Drugs May Up Risk of Parkinson's
Following stroke, 3–6% of patients develop acute symptomatic seizures within the first 7 days
Post-injury epilepsy (PIE) is a devastating, unpreventable consequence of traumatic brain injury (TBI) and stroke, which develops in 10 to 40 percent of survivors months, or even years later
5% epileptic seizures after stroke (8 posts to April 2021)
10% seizures post stroke (15 posts to April 2017)
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What’s the Connection Between Stroke, Seizures, and Epilepsy?
Stroke is the most common cause of epilepsy in the United States. Here’s what you need to know.
If you’ve had a stroke, you know that recovery can bring a lot of challenges. One among them: Navigating your increased risk of seizures. For stroke survivors and their loved ones, this is obviously scary. However, understanding the relationship between the two can help you understand what to do in the event of a seizure. Here, experts explain exactly how stroke, seizure, and epilepsy are linked, how to help someone having a stroke, and the importance of preventing a second stroke.
How Do Strokes Lead to Seizures?
A stroke occurs when a blood vessel leading to the brain becomes blocked or bursts. As a result, the brain is deprived of oxygen and nutrients, which causes brain cells to die and can lead to brain damage, according to the American Stroke Association.
Classic stroke symptoms can include paralysis, memory and vision loss, and speech and language difficulties. “In rare cases, someone might have seizures or they may have a combination of these symptoms,” says Samden Lhatoo, M.D., a professor of neurology at the McGovern Medical School at UTHealth Houston and the director of the Texas Comprehensive Epilepsy Program. A seizure is when a rush of abnormal electrical activity in the brain causes symptoms such as convulsions or complete lapses in awareness, according to the National Institute of Neurological Disorders and Stroke (NINDS).
More commonly, though, someone may have a seizure weeks or even months after a stroke. “This is a result of the damage that occurred due to the stroke,” Dr. Lhatoo says. A stroke can cause scarring that triggers electrical activity (or “short circuits”) in the brain, resulting in seizures, he explains.
The experience is not very common: About 7% of people who have a stroke experience a seizure after that stroke, according to a meta-analysis in the journal Topics in Stroke Rehabilitation. Still, if you’ve had a stroke, your risk of having a seizure and developing epilepsy is elevated relative to the average person and it’s something you should have on your radar. Dr. Lhatoo points to research in the journal Stroke that found that people who had a stroke were 10 times more likely to have seizures compared to the general population. That risk, he says, stays elevated for a decade or more following a stroke.
Types of Post-Stroke Seizures
Seizures following a stroke are divided in two categories, according to a review article on seizure and epilepsy after stroke published in the journal Drugs & Aging. These are:
Early seizures, or acute symptomatic seizures: These occur within a week of a stroke and come with a 30% risk of experiencing another seizure.
Late seizures, or remote asymptomatic seizures: These happen more than a week after a stroke. If you have one, the risk of experiencing another seizure is more than 60%.
Post-Stroke Seizures and Epilepsy
If you have two or more unprovoked seizures at least 24 hours apart, per NINDS, you may be diagnosed with epilepsy, a neurological condition in which problems with nerve cell communication causes seizures. Though seizures can have many causes, in the context of a stroke, an unprovoked seizure is one that occurs more than seven days after the stroke.
That said, having one seizure after a stroke does not mean you will develop epilepsy, according to the Centers for Disease Control and Prevention (CDC). In fact, the majority of people who have a stroke will not be diagnosed with epilepsy, says Dr. Lhatoo, (though some will). Still, according to the American Stroke Association, stroke is the most common cause of epilepsy in adults in the United States. The risk varies by age, but the association reports that in one group of 18- to 40-year-old stroke survivors, 13% went on to be diagnosed with epilepsy.
The Types of Strokes More Likely to Cause Seizures
Seizures aren’t predictable, but according to Parneed Grewal, M.D., an assistant professor in the division of vascular neurology in the department of neurology at the Medical University of South Carolina in Charleston, they may be more likely to occur if your stroke is:
Hemorrhagic (This is also known as a brain “bleed,” or when a weakened blood vessel ruptures and bleeds into the brain, affecting brain tissue, according to the American Stroke Association.)
Located in the cerebral cortex, the brain’s outer layer of tissue
Over a larger area of the brain
Severe
Your second (or third, etc.) stroke
How to Identify a Seizure
Despite what you may have heard, seizures don’t always result in a fall-to-floor loss of consciousness. And if you’re only on the lookout for convulsions, you could actually miss the signs of a seizure. If someone is having a seizure, you may notice some unusual behaviors, uncontrollable movements, and/or a loss of consciousness, according to Cure Epilepsy.
Older adults are at a greater risk for developing seizures, with stroke as a leading cause, according to the CDC. A seizure in this group may appear as memory problems, confusion, dizziness, numbness, or falling, which can also make identifying a seizure a challenge, the CDC says.
Some of the signs and symptoms of a post-stroke seizure can be difficult to spot. The specific symptoms depend on what type of seizure you’re having.
Symptoms of Focal Seizures
During a focal seizure (also known as a partial seizure), people remain fully awake and alert, and can remember what happened, says the Epilepsy Foundation. Symptoms involve:
A brief loss of consciousness, or going “blank,” being “frozen,” or showing confusion, per Dr. Lhatoo.
Symptoms last for less than two minutes, according to the Epilepsy Foundation.
Twitching of one limb on the opposite side where the stroke occurred in the brain, says Dr. Lhatoo.
Symptoms of Tonic-Clonic Seizures
These are also known as grand mal seizures. According to the Epilepsy Foundation, the following can happen during this type of seizure:
Convulsions
Loss of consciousness
Muscle stiffness
Symptoms lasting one to three minutes
How to Help Someone Having A Seizure
You can do a lot to help someone is having a seizure. According to the National Institute of Neurological Disorders and Stroke (NINDS), this includes:
Cushioning their head and loosening tight clothing around the neck
Not stopping them from moving. Don’t shake them, and don’t put anything into their mouth
Rolling them to their side
If this is their first seizure or it lasted more than 5 minutes, the NINDS advises calling 911.
How to Prevent Post-Stroke Seizures and Epilepsy
Although you can experience a seizure days, weeks, months, or even years after a stroke, your risk for having a seizure is at its highest right after the stroke. About 43% of people who have a seizure following a stroke do so within 24 hours, per the Epilepsy Foundation. Within the first two years after a stroke, 85% of people who develop epilepsy have their first seizure, according to the Drugs & Aging paper referenced above.
Following a stroke, there is no medication you can take to prevent seizures from starting, Dr. Lhatoo says. Anti-seizure medications will not be prescribed after your stroke because they do not have an impact on the development of epilepsy.
The most important thing you can do is try to prevent a second stroke from occurring, Dr. Lhatoo says. Why? The root cause of seizures in this case is the stroke. More worrisome, “a second stroke can be catastrophic or fatal,” he says. Unfortunately, one-fourth of stroke survivors will have another stroke, according to the American Stroke Association. To prevent that from happening, work to decrease your stroke risk factors, such as high blood pressure, elevated blood sugar, and abnormal cholesterol and triglyceride levels, he advises.
In addition, American Heart Association and American Stroke Association recommends limiting salt intake, not smoking, and doing cardiovascular exercise (such as brisk walking) for at least 10 minutes four days a week.
Outlook for Post-Stroke Seizure
If you have a seizure—no matter how long it’s been since your stroke—Dr. Lhatoo recommends getting assessed by a doctor who specializes in neurology, particularly one who focuses on epilepsy, if possible. “The right tests are important to ascertain an accurate diagnosis to put someone on the appropriate treatment,” he says. Diagnosis may involve the following tests, according to NINDS:
Brain scans, including computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET)
Blood tests
Developmental, neurological, and behavioral tests
Electroencephalogram (EEG) with or without video monitoring
Magnetoencephalogram (MEG)
Medical exam
If you are diagnosed with epilepsy following post-stroke seizures, it’s also advisable not to drive, work with machinery, or cook over open flame until seizures are well-controlled, he says. You will also want to consider if there are changes that need to be made to make your home safer after an epilepsy diagnosis.
If you’re diagnosed with epilepsy, the main treatment is antiseizure medication. Fortunately, "the majority of people respond really well to medication,” says Dr. Lhatoo. That’s why early diagnosis and treatment is so important.
Post-Stroke Seizure Numbers: Topics in Stroke Rehabilitation. (2015.) “The pooled incidence of post-stroke seizure in 102008 patients.” https://pubmed.ncbi.nlm.nih.gov/25920619/
Information On Stroke: American Stroke Association. (n.d.) “About Stroke.” https://www.stroke.org/en/about-stroke
Information On Epilepsy: Epilepsy Foundation. (n.d.) “What Is Epilepsy?” https://www.epilepsy.com/what-is-epilepsy
Unprovoked Seizure: StatPearls. (2023.) “Seizure.” https://www.ncbi.nlm.nih.gov/books/NBK430765
Long-Term Risk Of Post-Stroke Seizures: Stroke. (2018.) “Population-Based Assessment of the Long-Term Riks of Seizures in Survivors of Stroke.” https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.117.020178
Simple/Partial Seizures: Epilepsy Foundation. (n.d.) “Focal Onset Aware Seizures (Simple Partial Seizures).” https://www.epilepsy.com/what-is-epilepsy/seizure-types/focal-onset-aware-seizures
Tonic-Clonic Seizures: Epilepsy Foundation. (n.d.) “Tonic-clonic Seizures.” https://www.epilepsy.com/what-is-epilepsy/seizure-types/tonic-clonic-seizures
Categories of Post-Stroke Seizures And Short-Term Risk: Drugs & Aging. (2021.) “Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007525/
Prevent Second Stroke: American Heart Association. (2021.) “Risk of second stroke can be reduced with prevention efforts based on cause of first stroke.” https://newsroom.heart.org/news/risk-of-second-stroke-can-be-reduced-with-prevention-efforts-based-on-cause-of-first-stroke
Signs and Symptoms: Cure Epilepsy. (n.d.) “About Seizures.” https://www.cureepilepsy.org/for-patients/understanding/basics/what-is-seizure/
Help Someone With Seizure: National Institute of Neurological Disorders and Stroke. (2023.) “Epilepsy and Seizures.” https://www.ninds.nih.gov/health-information/disorders/epilepsy-and-seizures
Danger of Post-Stroke Seizure: American Stroke Association. (2020.) “Developing seizures after stroke may increase risk of death, disability.” https://newsroom.heart.org/news/developing-seizures-after-stroke-may-increase-risk-of-death-disability
Time Period Of Post-Stroke Seizure: Epilepsy Foundation. (n.d.) “Post-Stroke Seizures and Epilepsy: Frequently Asked Questions.” https://www.epilepsy.com/stories/post-stroke-seizures-and-epilepsy-frequently-asked-questions
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