[Post-stroke epilepsy]

Abstract

Background: Stroke (infarction or haemorrhage) is an important cause of epilepsy in adulthood, especially in the elderly. Because of a high incidence and improved survival, post-stroke epilepsy (PSE) is a great contemporary challenge for physicians. In our studies we have defined PSE as two or more seizures occurring more than four weeks after the stroke.

Material and methods: Based on our studies and a review of the literature, we give an account of the incidence, predictors, pathophysiology, and prognosis of PSE.

Results: The incidence in the literature varies greatly, from 2.3% to 43%. Our data shows an incidence of 2.5% after one year, increasing to 4.4% after five years. Severe strokes have higher incidence of PSE than minor strokes.

Interpretation: The variation in incidence reflects differences in the patient populations studied, definition of PSE, and study design. Our studies were prospective and in a well-defined area with high focus on admitting patients with any sign of stroke to hospital. This results in a "population" of stroke patients with severe strokes with high mortality rate, and patients with minor strokes not likely to develop PSE. In our material, severe strokes increased the incidence of PSE five-fold compared to minor strokes. We saw almost a doubling of the incidence one year to five years after the stroke. This might be explained by a long epileptogenesis, but it could also be due to high morbidity in this age group.