Antiseizure medications for primary and secondary seizure prevention after stroke

 What protocol will prevent these seizures from happening? The correct way to solve this secondary problem is to prevent it! Where is the research doing that?

We've known of this problem a long time. Provide solutions you blithering idiots!

• 10% seizures post stroke (19 posts to April 2017)

• 5% epileptic seizures after stroke (10 posts to April 2021)

• epileptic seizures (6 posts to December 2015)

• post-stroke epilepsy (14 posts to December 2016)

Antiseizure medications for primary and secondary seizure prevention after stroke

Zoe C. Wolcott, Brin E. Freund, William O. Tatum and Anteneh M. Feyissa*

Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, United States

Edited by

Giovanni Boero, SS Annunziata Hospital, Italy

Reviewed by

Mariangela Panebianco, University of Liverpool, United Kingdom

*Correspondence

Anteneh M. Feyissa, feyissa.anteneh@mayo.edu

Received 16 June 2025

Accepted 25 June 2025

Published 08 July 2025

Citation

Wolcott ZC, Freund BE, Tatum WO and Feyissa AM (2025) Antiseizure medications for primary and secondary seizure prevention after stroke. Front. Neurol. 16:1648064. doi: 10.3389/fneur.2025.1648064

Post-stroke seizures (PSS) and post-stroke epilepsy (PSE) are serious complications of cerebrovascular disease, contributing to morbidity, delayed recovery, cognitive decline, and mortality. PSS are classified as early (within 7 days) or late (after 7 days), with late-onset seizures often signaling the development of PSE. As stroke survival improves, the incidence of PSS continues to rise. Risk factors include cortical involvement, large or severe strokes, and early seizures. Although antiseizure medications (ASMs) are central to management, their use is limited by a lack of high-quality trials and reliable predictive tools. Routine primary prophylaxis is generally discouraged, except in high-risk patients—such as those with hemorrhagic stroke or severe cortical damage—while secondary prophylaxis after unprovoked seizures remains standard. Evidence supporting specific ASMs is limited, but lamotrigine and levetiracetam are considered reasonable first-line options. ASM selection should be individualized, particularly in older adults or those with cardiovascular or cognitive comorbidities, for whom older, enzyme-inducing ASMs carry greater risks. Withdrawal is often recommended after early seizures, but managing established PSE remains challenging without validated biomarkers. High-quality trials are urgently needed to evaluate the efficacy, safety, and tolerability of ASMs in post-stroke seizure prevention. Advancing the field also requires robust validation studies, improved prediction models, and personalized treatment strategies. This minireview summarizes current approaches to ASM use in PSS, with an emphasis on clinical decision-making for initiation and discontinuation.

Keywords

antiseizure medication; early seizure; late seizure; post-stroke seizures; stroke-related epilepsy; stroke; symptomatic epilepsy

1 Introduction

Post-stroke seizures (PSS) are classified as early (within 7 days) or late (after 7 days). Early seizures, or acute symptomatic seizures (ASS), result from transient neurochemical changes post-stroke and are not typically epileptic. Late seizures, or unprovoked seizures, stem from lasting structural brain changes and signify post-stroke epilepsy (PSE). The 7-day cutoff is widely accepted and aligns with underlying pathophysiology (1). Early seizures occur in 3–6% of stroke patients, more commonly in hemorrhagic (10–16%) than ischemic strokes (2–4%) (2, 3). Stroke causes 73% of acute symptomatic seizures in adults. Late seizures affect 3–5% using the 7-day definition, with incidence up to 12%. According to the International League Against Epilepsy (ILAE), PSE can be diagnosed after a single unprovoked seizure, as it reflects an enduring brain change with a high recurrence risk (>60% over 10 years) (1). Redefining PSE to include single late seizures has raised incidence estimates to 8–12% (1).

Risk factors for PSS include cortical involvement, severe or large strokes, and early seizures (2, 4, 5). Hemorrhagic strokes carry a higher PSE risk (12.4%) than ischemic ones (6.4%). Additional predictors include ICH volume, younger age, hyponatremia, alcohol use, and premorbid disability (4). Stroke treatments, including decompressive craniectomy, craniotomy, intravenous alteplase, or endovascular treatment, are also considered risk factors (3). Routine scalp electrocephalograpm (EEG) has not reliably predicted PSE, but focal epileptiform discharges and lateralized periodic patterns may carry prognostic value (6). Prediction models like the SeLECT score exist but need further validation before widespread use (7).

Studies indicate that PSS is associated with worse functional outcomes and increased disability. Patients with PSS have significantly higher modified Rankin Scale scores and greater odds of poor outcome (3). PSE also contributes to long-term morbidity. There is growing evidence linking PSE with increased dementia risk. A 2.5-fold higher dementia incidence was reported in young stroke survivors with seizures, and pooled analyses confirm that PSS is independently associated with dementia (8). This suggests a feed-forward relationship among stroke, PSS, and neurodegeneration (8).

This minireview discusses antiseizure medication (ASM) therapies for managing PSS, including clinical considerations for initiating and discontinuing treatment.

2 Primary prophylaxis

Routine primary prophylaxis ASMs after stroke is generally not recommended due to the low incidence of PSS or PSE and the significant risk of adverse drug reactions (ADRs), especially in older adults with comorbidities (9, 10). Professional guidelines reflect this: the European Stroke Organization gives a weak recommendation against primary prophylaxis due to very low-quality evidence, and the American Heart Association/American Stroke Association similarly advises against routine ASM use, noting that potential harms outweigh benefits for most survivors (10).

For most patients, harms outweigh the benefits of preventing a first seizure. However, certain high-risk groups may warrant selective primary prophylaxis briefly. Even then, decisions must carefully weigh seizure risk against ASM tolerability and ADRs (11, 12). Tools such as the SeLECT score for ischemic stroke and the CAVE and 2HELPS2B scores for ICH help quantify seizure risk (4, 12). These models include factors like cortical involvement, NIHSS severity, early seizure, and MCA distribution infarcts. Despite this, primary prophylaxis is rarely recommended, even in high-risk patients, as efficacy evidence remains sparse and low quality (9, 11).

Evidence for primary ASM prophylaxis after hemorrhagic stroke is limited. Two randomized trials assessed this: one comparing valproate to placebo in 72 ICH patients showed no significant benefit (13), while the PEACH trial testing levetiracetam yielded mixed results—some reduction in electrographic seizures but no effect on clinical seizures (14). Both were underpowered, with the PEACH trial halted early due to poor recruitment. A Cochrane review incorporating these studies concluded ASMs do not effectively prevent post-stroke seizures, rating the evidence as low quality due to imprecision (9). No trials support long-term prophylaxis for late unprovoked seizures. Two small studies on short-term prophylaxis post-ICH were inconclusive (11, 12).

Observational studies provide important insights. A real-world study in older adults with acute ischemic stroke found higher 30-day mortality among those receiving seizure prophylaxis within 7 days, raising concerns about net benefit (15). Decision models favor secondary over primary prophylaxis. One model showed that starting ASMs after a seizure consistently yields better quality-adjusted life years (QALYs) than primary prophylaxis (11). Another model for ICH suggested short-term prophylaxis (e.g., 7 days) may benefit select high-risk patients, but long-term use generally leads to worse outcomes due to ADRs (12, 16).

In conclusion, current evidence does not support routine primary prophylaxis with ASMs, though select high-risk patients may be considered. When ASMs are indicated, lamotrigine, levetiracetam, lacosamide, and oxcarbazepine are preferred for their safety profiles (15, 17).

More at link.

Predictive Factors of Acute Symptomatic Seizures in Patients With Ischemic Stroke Due to Large Vessel Occlusion

 Why the hell are you blithering idiots predicting seizures rather than preventing them from happening?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.

Predictive Factors of Acute Symptomatic Seizures in Patients With Ischemic Stroke Due to Large Vessel Occlusion

Lisa Marie Tako^1,2, Adam Strzelczyk^1,2*, Felix Rosenow^1,2, Waltraud Pfeilschifter³, Helmuth Steinmetz¹, Rejane Golbach⁴, Jan Hendrik Schäfer¹, Johann Philipp Zöllner^1,2 and Konstantin Kohlhase¹

• ¹Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
• ²LOEWE Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt, Germany
• ³Department of Neurology and Neurophysiology, Lüneburg Hospital, Lüneburg, Germany
• ⁴Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany

Introduction: Acute symptomatic seizures (ASz) after ischemic stroke are associated with increased mortality; therefore, identifying predictors of ASz is important. The purpose of this study was to analyze predictors of ASz in a population of patients with ischemic stroke due to large arterial vessel occlusion (LVO).

Materials and Methods: This retrospective study examined patients with acute ischemic stroke caused by LVO between 2016 and 2020. Identification of predictive factors was performed using univariate and subsequent multiple logistic regression analysis. In addition, subgroup analysis regarding seizure semiology and time of seizure occurrence (≤ 24 h and > 24 h after stroke) was performed.

Results: The frequency of ASz among 979 patients was 3.9 % (n = 38). Univariate logistic regression analysis revealed an increased risk of ASz in patients with higher National Institutes of Health Stroke Scale (NIHSS) score at admission or 24 h after admission, hypernatremia at admission ≥ 145 mmol/L, and pneumonia. Further multiple logistic regression analysis revealed that NIHSS 24 h after admission was the strongest predictor of ASz, particularly relating to ASz occurring later than 24 h after stroke. Patients who experienced a seizure within the first 24 h after stroke were more likely to have a generalized tonic-clonic (GTCS) and focal motor seizure; beyond 24 h, seizures with impaired awareness and non-convulsive status epilepticus were more frequent.

Conclusion: NIHSS score 24 h after admission is a strong predictive factor for the occurrence of ASz in patients with ischemic stroke caused by LVO. The semiology of ASz varied over time, with GTCS occurring more frequently in the first 24 h after stroke.

Introduction

Cerebrovascular disease is the most common cause of epilepsy in the elderly, accounting for up to 39–49% of all newly diagnosed epilepsies in patients aged > 60 years (1, 2). Due to demographic changes, the incidence of stroke-related epilepsy is expected to rise and pose an increasing challenge for the healthcare system (3). Depending on the time course, seizures after stroke are defined according to the International League Against Epilepsy (ILAE) either as an acute symptomatic seizure (ASz) if they occur within 7 days, or as an unprovoked late seizure if they occur later than 7 days (4). Acute symptomatic seizures are thought to result from local cellular biochemical dysfunction of electrically excitable tissues, whereas late seizures are caused by post-ischemic remodeling of the damaged brain tissue and neuronal network, leading to an acquired predisposition to seizures and the diagnosis of post-stroke epilepsy (5–8). A large systemic review and meta-analysis examined the frequency of seizures after ischemic stroke; the frequency of ASz was found to be 3.3% and the late post-stroke seizure frequency was 1.8% (9). Because ASz are associated with an increased risk of mortality, knowledge of predictive factors is essential (10, 11). Various risk factors with different levels of evidence are described in the literature. The severity of stroke, estimated by the National Institutes of Health Stroke Scale (NIHSS), and cortical involvement were identified as independent risk factors for the occurrence of ASz (11–16). Data are inconclusive regarding other possible risk factors, such as cardioembolic infarct etiology, anterior circulation cerebral infarction, hemorrhagic transformation, previous transient ischemic attack (TIA), acute non-neurological infection, and history of diabetes mellitus (10, 11, 13, 17). Based on these results, different prediction models have been developed to assess the individual risk for post-stroke seizures (18, 19). Furthermore, therapy with statins in the acute phase of stroke was reported to reduce the rate of seizures (20). Systemic thrombolysis and mechanical thrombectomy as established reperfusion procedures have also been the subject of research, with recent studies showing no association with ASz frequency (21, 22).

The variability among identified predictive factors may be explained by the heterogeneous designs of the available studies, with varying levels of evidence (registry studies, retrospective and prospective designs, mono- or multi-centric studies, systematic reviews), inclusion criteria (hemorrhagic and ischemic stroke), and definitions of ASz occurring later than 7 days (17, 23, 24). Furthermore, the studies were conducted over an extended period, including several studies in which neurological treatment in stroke units differed and new therapeutic milestones, such as mechanical recanalization, had not yet been established.

The purpose of this study is to analyze predictive factors for ASz in a well-defined patient population who experienced an ischemic stroke due to large vessel occlusion (LVO) and who were treated after mechanical recanalization had become the standard therapy for LVO in 2016.

More at link.

 

Ambulatory seizure forecasting with a wrist-worn device using long-short term memory deep learning

 Does your doctor already have a protocol to prevent post stroke epilepsy and seizures? 

Your risk of post-stroke seizure is highest in the first 30 days following a stroke. Approximately 5 percent of people will have a seizure within a few weeks after having a stroke, according to the National Stroke Association.

Ambulatory seizure forecasting with a wrist-worn device using long-short term memory deep learning

 

• Mona Nasseri,
• Tal Pal Attia,
• Boney Joseph,
• Nicholas M. Gregg,
• Ewan S. Nurse,
• Pedro F. Viana,
• Gregory Worrell,
• Matthias Dümpelmann,
• Mark P. Richardson,
• Dean R. Freestone &
• Benjamin H. Brinkmann 

Scientific Reports volume 11, Article number: 21935 (2021) Cite this article

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Abstract

The ability to forecast seizures minutes to hours in advance of an event has been verified using invasive EEG devices, but has not been previously demonstrated using noninvasive wearable devices over long durations in an ambulatory setting. In this study we developed a seizure forecasting system with a long short-term memory (LSTM) recurrent neural network (RNN) algorithm, using a noninvasive wrist-worn research-grade physiological sensor device, and tested the system in patients with epilepsy in the field, with concurrent invasive EEG confirmation of seizures via an implanted recording device. The system achieved forecasting performance significantly better than a random predictor for 5 of 6 patients studied, with mean AUC-ROC of 0.80 (range 0.72–0.92). These results provide the first clear evidence that direct seizure forecasts are possible using wearable devices in the ambulatory setting for many patients with epilepsy.

Introduction

Despite optimized medication therapy, resective surgery, and neuromodulation therapy, many people with epilepsy continue to experience seizures. Half or more of patients who undergo resective surgery for epilepsy have eventual recurrence of seizures^{1, 2}, and devices for neuromodulation rarely achieve long-term seizure freedom^{3, 4}. People living with epilepsy consistently report the unpredictability of seizures to be the most limiting aspect of their condition⁵. Reliable seizure forecasts could potentially allow people living with recurrent seizures to modify their activities, take a fast-acting medication, or increase neuromodulation therapy to prevent or manage impending seizures. Accurate seizure forecasts have been demonstrated using invasively sampled ultralong-term EEG in ambulatory canine^6,7,8 and human subjects^{9,10,11,12,13,14}, including a prospective study with a dedicated device¹¹. However, invasive devices may not be acceptable for some patients with epilepsy, and no clinically available invasive device currently has the capability to sample and telemeter data needed for seizure forecasting. Hence there is presently great interest in forecasting seizures using wearable or minimally invasive devices. Deep learning approaches have shown promising performance for a variety of difficult applications¹⁵, including seizure forecasting⁷. In particular these “end-to-end learning” methods are attractive for seizure forecasting given the challenges of identifying salient features in ultra-long term time-series data, and the heterogeneity in time series data characteristics between different patients. The power and capability of deep learning algorithms trained on very large datasets hold promise to enable applications not previously believed possible, and may open the door to seizure forecasting with noninvasive sampling devices.

Many challenges exist in designing a reliable system for forecasting seizures from noninvasively recorded data. Training, testing, and validating a forecasting algorithm requires ultra-long duration recordings with an adequate number of seizures. Additionally, concurrent video and/or EEG validation of seizures in an ambulatory setting over months to years is logistically difficult, and is not possible using conventional in-hospital monitoring methods. Self-reported seizure diaries are the most accessible validation, but the poor reliability of such diaries is widely recognized^{11, 16}. Performing device studies on in-hospital patients with concurrent video-EEG validation is logistically feasible, but such studies are expensive, and limited in duration, and restrict normal daily activities which could produce false alarms, such as exercise, brushing teeth, or other activities. Because of these challenges an ILAE-IFCN working group recently published guidelines¹⁷ for seizure detection studies with non-invasive wearable devices, but few studies achieve phase 3–4 evidence in an ambulatory setting¹⁸. In studies of seizure forecasting it is imperative that ambulatory data including the full range of normal activities be included in the training, testing, and validation sets.

Seizure prediction with wearable devices was recently investigated in a cohort of in-hospital patients¹⁹ using a cross-patient deep learning algorithm on data recorded from Empatica E4 devices. The dataset was comprised of multiday recordings from 69 epilepsy patients (28 female, duration 2311.4 h, 452 seizures). In a leave-one-patient-out cross-validation approach, they achieved better than chance prediction in 43% of patients, with no difference in performance between generalized and focal seizure types. It has also been shown that seizure occurrence can be modeled as circadian or multiday patterns of seizure risk over long periods^{20, 21}, and these patterns may be used to forecast seizures²². Using a mobile electronic seizure diary application²¹ seizure forecasts calculated based on circadian and multiday seizure cycles using data from 50 application users produced accurate forecasts for approximately half the cohort. Long-term cycles of seizure risk offer complementary information to direct forecasting of seizures, and signals from wearable fitness trackers have been shown to have value in identifying circadian and multidian cycles of seizure risk²³.

This study aimed to develop a wearable seizure forecasting system for ambulatory use, and to evaluate the forecasting performance relative to seizures identified with concurrent chronic intracranial EEG (iEEG).

Diagnostic Yield of Electroencephalography When Seizure Is Suspected in Acute Ischemic Stroke

 What is much more important is protocols to prevent these seizures. Where are they?

Diagnostic Yield of Electroencephalography When Seizure Is Suspected in Acute Ischemic Stroke

Show all authors

Mohanad AlGaeed, MD, Manjot Grewal, MD, Prarthana Hareesh, MD, ...

First Published June 4, 2021 Research Article 

https://doi.org/10.1177/19418744211021224

Article information

Abstract

Introduction:

Seizures are a common complication after an ischemic stroke. Electroencephalography can assist with the diagnosis of seizures however, the diagnostic yield of its use when seizure is suspected in the setting of acute ischemic stroke is unknown. We aim to evaluate the yield and cost of EEG in the acute ischemic stroke setting.

Methods:

We conducted a retrospective chart review of patients admitted to a single academic tertiary care center in the United States between September 1, 2015 to November 30, 2019 with a primary diagnosis of acute ischemic stroke and who were monitored on electroencephalography (EEG) for suspected seizures (total number of 70 patients). The primary outcome was how often EEG monitoring changed clinical management defined as starting, stopping, or changing the dose of an anti-epileptic drug. Secondary analysis was estimating the cost of EEG monitoring per change in management.

Results:

We identified 126 patients admitted with acute ischemic stroke who underwent EEG of which 70 met all inclusion and exclusion criteria. EEG monitoring resulted in a change in management in 22 patients (31%). Predictors associated with EEG monitoring resulting in a change in management were admission to the ICU, pre-existing atrial fibrillation, and symptomatic hemorrhagic transformation. Estimated cost of EEG per change in management was $1374.96 USD.

Conclusion:

EEG monitoring resulted in a changed management in nearly one-third of patients admitted with acute ischemic stroke suspected of having seizures.

Keywords stroke, cerebrovascular disorders, epilepsy, clinical specialty, electroencephalography, techniques, seizures, epilepsy

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Effects of double-dose statin therapy for the prevention of post-stroke epilepsy: A prospective clinical study

 Does your doctor already have a protocol to prevent post stroke epilepsy and seizures? 

Your risk of post-stroke seizure is highest in the first 30 days following a stroke. Approximately 5 percent of people will have a seizure within a few weeks after having a stroke, according to the National Stroke Association.

Effects of double-dose statin therapy for the prevention of post-stroke epilepsy: A prospective clinical study

• Yanmei Zhu ^#
• Haiyan Gou ^#
• Long Ma ^#
• 
  
• Jia He
• Yan Chen
• Yulan Zhu
• Show all authors
• Show footnotes

Published:April 14, 2021DOI:https://doi.org/10.1016/j.seizure.2021.04.010

Highlights

• •
  Double-dose statin treatment reduces the incidence of post-stroke epilepsy (PSE) during the acute phase of ischemic stroke, which is better than a standard-dose.
• •
  PSE incidence was higher in patients under 65 years of age, and more males than females were affected.
• •
  The majority of PSE occurred between 6 and 12 months after the beginning of statin treatment.

ABSTRACT

Background

: To determine treatment effects on the incidence of post-stroke epilepsy (PSE) using different doses of statin, a prospective hospital-based cohort study was designed to explore whether a double-dose statin treatment can better prevent the occurrence of PSE.

Methods

:A total of 1152 patients with newly diagnosed ischemic stroke admitted to our hospital from March to August 2017 were selected, 1033 of whom were followed-up. Patients were divided into two treatment groups:(1) standard-dose (20 mg atorvastatin or 10 mg rosuvastatin,daily oral; 788 patients); and (2) double-dose (40 mg atorvastatin or 20 mg rosuvastatin, daily oral; 245 patients).At 18 months follow-up was conducted to compare the incidence of PSE between groups.

Results

: In general, in the standard-dose group we observed two cases of early seizure (ES) (0.25%), 22 cases oflate seizure (LS) (2.79%) and 20 cases of PSE (2.54%). In the double-dose group, onepatient had ES (0.41%), two patients had LS (0.82%), and onepatient had PSE (0.41%). The incidence of PSE was significantly lower in the double-dose group as compared to the standard-dose group. There was a higher proportion of PSE in patients younger than 65 years and in males. Three patients had ES; one presented with focal aware seizure (FAS), and two had focal to bilateral tonic-clonic seizure (FBTCS). Among the 21 patients with PSE, there were two cases of FAS, five cases of focal impaired awareness seizure (FIAS), five cases of FBTCS, and nine cases of GTCS, suggesting that partial seizure is the most common type of PSE. Cerebral cortex was involved in 85.75% of cases with PSE, and multiple lobes were involved in 61.9% of cases with PSE.

Conclusion

: Increasing the dose of statin treatment during the acute phase of ischemic stroke reduces the incidence of PSE. Further research is needed to understand the mechanisms underlying the potential preventative effects of statins against PSE.

Functional Seizures Associated With Stroke, Psychiatric Disorders

 So for those diagnosed with seizures, does your doctor have the correct diagnosis and treatment?

Earlier research says this:

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 

 

seizures occur in about 10% of stroke patients. 

The latest here:

Functional Seizures Associated With Stroke, Psychiatric Disorders

In a large-scale study of electronic health records (EHRs), researchers have determined the prevalence of functional seizures and characterised comorbidities associated with them.

The research team, headed by Lea Davis, PhD, Vanderbilt Genetics Institute, Nashville, Tennessee, confirmed associations between functional seizures and psychiatric disorders including posttraumatic stress disorder, anxiety, and depression as well as sexual assault trauma. They also discovered a novel association between functional seizures and cerebrovascular disease, including stroke.

The findings were reported in JAMA Network Open.

About 80% of patients experiencing functional seizures are initially misdiagnosed with epilepsy and treated with anti-epileptic drugs, said Slavina Goleva, Vanderbilt University. An accurate diagnosis requires assessment with video electroencephalogram (EEG).

“We initially recognised that finding these patients within the EHR would be a challenge because the ICD [International Classification of Diseases] codes are not as specific as they are for a lot of diseases,” she said.

In addition to ICD codes, the researchers included Current Procedural Terminology (CPT) codes and used natural language processing to search within the records for a list of keywords. The researchers manually reviewed charts to confirm that the algorithm correctly identified patients with functional seizures. The study included more than 2.3 million patients aged 18 years and older in the VUMC-EHR system from 1989 to 2018. The researchers identified 3,341 patients with functional seizures, 74% of whom were women. They calculated a prevalence of 0.14% (140 cases per 100,000 people); previous estimates ranged from 2 to 33 cases per 100,000 people.

“Our report is the first direct calculation of the prevalence of functional seizures,” Goleva said, noting that the epilepsy monitoring unit at VUMC may result in a higher prevalence of functional seizures in patients in the VUMC-EHR compared with the general population.

Among the patients with functional seizures, the researchers validated comorbidities including psychiatric disorders and sexual assault trauma and discovered a novel association with cerebrovascular disease. They also found that sexual assault trauma explained about a quarter of the increased rate of functional seizures among women.

“Functional seizures are not occurring in isolation,” said Dr. Davis. “Patients who are experiencing these seizures are also experiencing a higher burden of additional healthcare issues.”

The researchers recommended that patients experiencing seizures who have psychiatric comorbidities or a history of sexual assault trauma be referred for video-EEG assessment. Patients who develop seizures after a stroke and do not initially respond to treatment with medications should also be considered for early video-EEG assessment.

Up to 30% of patients referred for video-EEG are eventually diagnosed with functional seizures, they noted.

“It’s frustrating that there is no ICD code for functional seizures, given how common the diagnosis is and the fact that codes exist for strange things like alligator bite, second occurrence,” said Dr. Davis. “It really emphasises how little attention this population of patients has gotten.”

Reference: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774486

SOURCE: Vanderbilt University Medical Center

 

Immune cells in the brain may help prevent seizures

For your risk of seizures post stroke you want your doctor to closely follow this. 

 SO WHAT THE FUCK IS THE SOLUTION TO PREVENT THOSE SEIZURES? You are supposed to solve problems, not just lazily describe them.

Earlier research says this:

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 

 

seizures occur in about 10% of stroke patients. 

The latest here:

Immune cells in the brain may help prevent seizures

 

Research in mice reveals that immune cells in the brain constantly survey their neighborhood for overexcited nerve cells. The findings could shed light on neurological conditions in which nerves are “hyperexcitable,” such as epilepsy and Alzheimer’s disease.

Image credit: CHRISTOPH BURGSTEDT/SCIENCE PHOTO LIBRARY/Getty Images

Night and day, immune cells in the brain called microglia restlessly extend and retract branch-like “processes” into their surroundings.

The established view among neuroscientists has been that the cells are looking for invading pathogens or evidence of damage.

“This never made sense to me,” says Dr. Katerina Akassoglou, a senior investigator at Gladstone Institutes in San Francisco, CA.

“Why would a cell expend so much energy for something that might never happen? I always thought there must be another reason for microglia to be moving all the time, likely related to a normal function in the brain,” she adds.

Dr. Akassoglou and her colleagues have now shown that the cells use their processes to monitor neighboring nerve cells for signs of overexcitement. When they touch overactive cells, the processes somehow limit their activity and prevent seizures.

“Microglia seem to sense which neuron is about to become overly active, and keep it in check by making contact with it, which prevents that neuron’s activity from escalating,” explains Dr. Mario Merlini, the study’s co-first author and a former research scientist in Dr. Akassoglou’s lab who now heads a team at the University of Caen Normandie in France.

Inactive microglia

Hyperexcitable neurons are known to be involved in a wide range of neurological conditions, including Alzheimer’s disease, traumatic brain injury, epilepsy, and autism.

After years of trying, researchers in Dr. Akassoglou’s lab managed to create a strain of mice called Mg^PTX, in which the microglia are alive but unable to send out processes.

“It was purely driven by curiosity,” says Dr. Akassoglou. “We just wanted to know, why do these cells move all the time, and what happens to the brain if they stop?”

For a while, the mice appeared to be fine, but then some of them began to have seizures.

Seizures occur when there is an uncontrolled burst of electrical activity in the brain.

To observe the effects of overstimulation on a discrete part of the mouse brain, the scientists developed a novel technique for continually tickling the whiskers of normal and Mg^PTX mice as they ran on a wheel.

The automated whisker stimulation model allowed the scientists to image overactive neurons in the whisker barrel cortex of the mouse brain, where processing of signals from the whiskers takes place.

The researchers discovered that in genetically normal mice, microglia primarily extend their processes toward active neurons.

Crucially, the researchers discovered that when a process touches an active neuron, the cell’s activity does not increase any further. By contrast, in Mg^PTX mice — whose microglia cannot send out branches — this calming of hyperexcitable nerves does not occur.

“[I]n our mouse model where microglia movements are frozen, we found that the activity of nearby neurons keeps increasing, a bit like a heater with a broken thermostat,” says Dr. Merlini.

“This changed our thinking on how neuronal activity is regulated in the brain. Instead of an on-off switch, microglia are the brain’s thermostat, controlling excessive neuronal activity,” he explains.

The scientists report their research in the journal Nature Neuroscience.

Incidence and Association of Reperfusion Therapies With Poststroke Seizures

 SO WHAT THE FUCK IS THE SOLUTION TO PREVENT THOSE SEIZURES? You are supposed to solve problems, not just lazily describe them.

Earlier research says this:

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 

 

seizures occur in about 10% of stroke patients.  

Just maybe you want your doctor to try these solutions.

Cannabidiol May Reduce Seizures by Half in Hard-to-treat Epilepsy

Or maybe the nasal spray referred to in here:

Preventing Seizure-Caused Damage to the Brain

The answers are out there, does your doctor know about them? 

Mozart may reduce seizure frequency in people with epilepsy

 

A dietary supplement dampens the brain hyperexcitability seen in seizures or epilepsy

 

The latest here: 

Incidence and Association of Reperfusion Therapies With Poststroke Seizures

A Systematic Review and Meta-Analysis

Alain Lekoubou

,

Jonah Fox

,

Paddy Ssentongo

Originally published10 Aug 2020https://doi.org/10.1161/STROKEAHA.119.028899Stroke. 2020;51:2715–2723

Abstract

Background and Purpose:

We performed a systematic review and meta-analysis to assess the incidence and risk of seizures following acute stroke reperfusion therapy (intravenous thrombolysis [IVT] with r-tPA [recombinant tissue-type plasminogen activator], mechanical thrombectomy or both).

Methods:

We searched major databases (MEDLINE, SCOPUS, and Cochrane Library) for articles published between 1995 and October 28, 2019. The primary outcome was the overall and treatment specific pooled incidence of poststroke seizures (PSS) following acute reperfusion therapy. We also computed the pooled incidence of early poststroke seizures and late poststroke seizures separately for all studies. We derived the risk of PSS associated with IVT in the pooled cohort of patients who received only IVT. The small number of studies (<3) that reported on the risk of PSS associated with mechanical thrombectomy alone or in combination with IVT did not allow us to compute an estimate of the risk of seizures associated with this therapy.

Results:

We identified 13 753 patients with stroke, of which 592 had seizures. The pooled incidence of PSS was 5.9 % (95% CI, 4.2%–8.2%). PSS incidence rates among patients with stroke treated with IVT, mechanical thrombectomy, and both were respectively 6.1% (95% CI, 3.6%–10.2%), 5.9% (95% CI, 4.1%–8.4%), and 5.8 % (95% CI, 3.0%–10.9%). The incidence of late PSS was 6.7% (95% CI, 4.01%–11.02%) and that of early PSS was 3.14% (95% CI, 2.05%–4.76%). The pooled odds ratio for the association between IVT and PSS was 1.24 (95% CI, 0.75–2.05).

Conclusions:

The findings of this meta-analysis suggest that about one in 15 ischemic stroke patients treated with IVT, mechanical thrombectomy, or both develop seizures independently of the specific reperfusion treatment that they received.

Footnotes

For Sources of Funding and Disclosures, see page 2722.

The Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.119.028899.

Correspondence to: Alain Lekoubou, MD, MSc, Department of Neurology, Penn State University, 30 Hope Dr, Hershey, PA, 17033. Email alekouboulooti@pennstatehealth.psu.edu

 

Incidence and Association of Reperfusion Therapies With Poststroke Seizures

 Lazy, lazy, lazy. Describes a problem, offers NO solution. These people need to be removed from stroke and if we had ANY STROKE LEADERSHIP AT ALL, that would occur.

Incidence and Association of Reperfusion Therapies With Poststroke Seizures

 

A Systematic Review and Meta-Analysis

Alain Lekoubou

,

Jonah Fox

,

Paddy Ssentongo

Originally published10 Aug 2020https://doi.org/10.1161/STROKEAHA.119.028899Stroke. ;0

Abstract

Background and Purpose:

We performed a systematic review and meta-analysis to assess the incidence and risk of seizures following acute stroke reperfusion therapy (intravenous thrombolysis [IVT] with r-tPA [recombinant tissue-type plasminogen activator], mechanical thrombectomy or both).

Methods:

We searched major databases (MEDLINE, SCOPUS, and Cochrane Library) for articles published between 1995 and October 28, 2019. The primary outcome was the overall and treatment specific pooled incidence of poststroke seizures (PSS) following acute reperfusion therapy. We also computed the pooled incidence of early poststroke seizures and late poststroke seizures separately for all studies. We derived the risk of PSS associated with IVT in the pooled cohort of patients who received only IVT. The small number of studies (<3) that reported on the risk of PSS associated with mechanical thrombectomy alone or in combination with IVT did not allow us to compute an estimate of the risk of seizures associated with this therapy.

Results:

We identified 13 753 patients with stroke, of which 592 had seizures. The pooled incidence of PSS was 5.9 % (95% CI, 4.2%–8.2%). PSS incidence rates among patients with stroke treated with IVT, mechanical thrombectomy, and both were respectively 6.1% (95% CI, 3.6%–10.2%), 5.9% (95% CI, 4.1%–8.4%), and 5.8 % (95% CI, 3.0%–10.9%). The incidence of late PSS was 6.7% (95% CI, 4.01%–11.02%) and that of early PSS was 3.14% (95% CI, 2.05%–4.76%). The pooled odds ratio for the association between IVT and PSS was 1.24 (95% CI, 0.75–2.05).

Conclusions:

The findings of this meta-analysis suggest that about one in 15 ischemic stroke patients treated with IVT, mechanical thrombectomy, or both develop seizures independently of the specific reperfusion treatment that they received.

Footnotes

For Sources of Funding and Disclosures, see page XXX.

The Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.119.028899.

Correspondence to: Alain Lekoubou, MD, MSc, Department of Neurology, Penn State University, 30 Hope Dr, Hershey, PA, 17033. Email alekouboulooti@pennstatehealth.psu.edu

Clinical features of poststroke epileptic seizures

I doubt anything useful came out of this, survivors don't need what those features are, they need to prevent seizures. WHEN THE HELL WILL YOU PROVIDE THAT?

Clinical features of poststroke epileptic seizures

Клинические особенности постинсультных эпилептических припадков.  Neurology, Neuropsychiatry, Psychosomatics , Volume 7(1S) , Pgs. 47-53.

NARIC Accession Number: I245666.  What's this?
Author(s): Danilova T.V.
Publication Year: 2015.
Abstract: The objective of this study was to explore the clinical features of epileptic seizures in stroke, risk factors for their development to form the bases for prediction, and elaboration of optimal therapy. Poststroke epileptic seizures are detected in  over 60 years of age. For the study, 468 patients with ischemic stroke were examined. A study group included 265 patients (176 men and 89 women) aged 31–89 years with epileptic seizures, while a control group comprised 203 non-epileptic patients (126 men and 77 women) aged 31–91 years. The patients of both groups were matched for age, clinical characteristics, and pathogenetic subtypes of stroke. Instrumental examinations were performed in the attack-free interval. Neurological status was evaluated using conventional procedure (the National Institute of Health Stroke Scale); brain magnetic resonance imaging (MRI), magnetic resonance angiography, electroencephalography, extra- and transcranial duplex sound of cerebral vessels, by estimating the level and degree of stenosis and cerebrovascular responsiveness. Focal seizures were noted to develop more frequently with a preponderance of simple partial seizures within the first 7 days of stroke, with neurological worsening in the acute period of the disease. Stroke in the left carotid and vertebrobasilar beds may provoke the development of early seizures. The cortical localization of ischemic foci and pre-stroke chronic brain ischemia with the signs of circulatory comorbidity in the anterior and posterior circulatory systems may be a risk factor of epileptic seizures. There was an association of the type of epileptic seizure and the size of ischemic focus, as evidenced by MRI, with a tendency towards the generalization of seizures in the extensive ischemic foci. A tendency toward the generalization of epileptic seizures was established in the development of stroke in the left carotid bed, as well as in critical stenoses and occlusions of the great cerebral vessels.
Descriptor Terms: Epilepsy, Risk factors, Stroke, Therapy.
Language: Russian
Geographic Location(s): Europe, Russia.

Can this document be ordered through NARIC's document delivery service*?: Request Information.
Get this Document: https://nnp.ima-press.net/nnp/article/viewFile/475/458.

Citation: Danilova T.V. (2015). Clinical features of poststroke epileptic seizures.  Клинические особенности постинсультных эпилептических припадков.  Neurology, Neuropsychiatry, Psychosomatics , 7(1S), Pgs. 47-53. Retrieved 10/22/2019, from REHABDATA database.

Monthly cycles of brain activity linked to seizures in patients with epilepsy

If you are one of the  10% of stroke patients having seizures  you'll want to discuss this with your doctor for possible options to plan your seizures.
https://www.news-medical.net/news/20180108/Monthly-cycles-of-brain-activity-linked-to-seizures-in-patients-with-epilepsy.aspx
 

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January 8, 2018

UC San Francisco neurologists have discovered monthly cycles of brain activity linked to seizures in patients with epilepsy. The finding, published online January 8 in Nature Communications, suggests it may soon be possible for clinicians to identify when patients are at highest risk for seizures, allowing patients to plan around these brief but potentially dangerous events.
"One of the most disabling aspects of having epilepsy is the seeming randomness of seizures," said study senior author Vikram Rao, MD, PhD, an assistant professor of neurology at UCSF and member of the UCSF Weill Institute for Neurosciences. "If your neurologist can't tell you if your next seizure is a minute from now or a year from now, you live your life in a state of constant uncertainty, like walking on eggshells. The exciting thing here is that we may soon be able to empower patients by letting them know when they are at high risk and when they can worry less."
Epilepsy is a chronic disease characterized by recurrent seizures -- brief storms of electrical activity in the brain that can cause convulsions, hallucinations, or loss of consciousness. Epilepsy researchers around the world have been working for decades to identify patterns of electrical activity in the brain that signal an oncoming seizure, but with limited success. In part, Rao says, this is because technology has limited the field to recording brain activity for days to weeks at most, and in artificial inpatient settings.
At UCSF Rao has pioneered the use of an implanted brain stimulation device that can quickly halt seizures by precisely stimulating a patient's brain as a seizure begins. This device, called the NeuroPace RNS® System, has also made it possible for Rao's team to record seizure-related brain activity for many months or even years in patients as they go about their normal lives. Using this data, the researchers have begun to show that seizures are less random than they appear. They have identified patterns of electrical discharges in the brain that they term "brain irritability" that are associated with higher likelihood of having a seizure.

The new study, based on recordings from the brains of 37 patients fitted with NeuroPace implants, confirmed previous clinical and research observations of daily cycles in patients' seizure risk, explaining why many patients tend to experience seizures at the same time of day. But the study also revealed that brain irritability rises and falls in much longer cycles lasting weeks or even months, and that seizures are more likely to occur during the rising phase of these longer cycles, just before the peak. The lengths of these long cycles differ from person to person but are highly stable over many years in individual patients, the researchers found.
The researchers show in the paper that when the highest-risk parts of a patient's daily and long-term cycles of brain irritability overlap, seizures are nearly seven times more likely to occur than when the two cycles are mismatched.
Rao's team is now using this data to develop a new approach to forecasting patients' seizure risk, which could allow patients to avoid potentially dangerous activities such as swimming or driving when their seizure risk is highest, and to potentially take steps (such as additional medication doses) to reduce their seizure risk, similar to how people with asthma know to take extra care to bring their inhalers when pollen levels are high.
"I like to compare it to a weather forecast," Rao said. "In the past, the field has focused on predicting the exact moment a seizure will occur, which is like predicting when lightning will strike. That's pretty hard. It may be more useful to be able tell people there is a 5 percent chance of a thunderstorm this week, but a 90 percent chance next week. That kind of information lets you prepare."

Source:

https://www.ucsf.edu/