CHICAGO – People who suffer from a stroke are seven times more likely to develop epilepsy.
Stroke survivors and their caregivers need to be aware of the risk and learn to recognize the
often-subtle symptoms of seizures to ensure timely treatment, suggests an Epilepsy Currents
commentary synthesizing recent research. The publication is the journal of the American Epilepsy Society.
“People increasingly are surviving stroke because we’re getting better at diagnosing and
treating it, but this also means more people are at risk for developing epilepsy,” said Adriana
Bermeo-Ovalle, M.D., author of the commentary and associate professor of neurology at Rush
University Medical Center, Chicago. “Many stroke survivors – and their doctors – don’t realize
strokes and seizures can be related. The good news is research helps identify those at highest
risk, so they, their family members, caregivers and health care providers can be more
Epilepsy is a complex disease of the brain that causes sudden and unpredictable seizures.
While it affects people of all ages, it is more common in infants, children and older adults.
Because it damages the brain, stroke can lead to the development of epilepsy.
Nearly 1 in 10 people (9.27%) who had a stroke developed seizures within 10 years, according
to a recent study of 859,260 people, which combined data from emergency department visits
and hospitalizations in California, Florida and New York and a 5% sample of Medicare
beneficiaries nationwide.1 People may develop seizures soon after having a stroke, or many
Another study demonstrates that an instrument, called SeLECT, can help predict who is at
highest risk, based on five factors which are assigned points: severity of stroke (0-3); blockage
in a large artery (0 or 1); experiencing seizures the first week after the stroke (0 or 1); stroke
involving the cortex, the outer surface of the brain (0 or 3); and stroke caused by a blockage
in the middle cerebral artery (0 or 1).2 Patients receive a score from 0 to 9. Researchers
tested the instrument in 1,169 people from three international studies and found that, among
those determined by the instrument to be at highest risk (9 points), 63% developed seizures
within one year and 83% within five years. Among those at the lowest risk (0 points), 0.7%
developed seizures within one year and 1.3% developed seizures within five years.
Most strokes (87%) are ischemic, meaning they are caused by a blockage of an artery in the
brain. Others are caused by bleeding in the brain (hemorrhagic). People who have a
hemorrhagic stroke are at increased likelihood for seizures, more so if the
bleeding affects the cortex.
Those determined to be at high risk – as well as their caregivers and
healthcare providers – should be told what symptoms of seizures may
look like, such as lack of activity, behavior changes, excessive
sleepiness and slowed recovery.
If stroke survivors are determined to be at high risk for seizures their healthcare providers
should consider asking about subtle seizure symptoms and get diagnostic tests such as an EEG
(electroencephalogram) if necessary. If these tests are positive, they may recommend antiepileptic drugs (AEDs), she said.
Treatment to prevent the development of epilepsy is not yet available but it’s still helpful to
be proactive in the identification of symptoms and early diagnosis. For example, stroke
survivors should learn early signs of a seizure so they can get to a safe place or get help,
avoid high-risk activities such as driving and get adequate treatment so they can recover to
their maximum potential. Their healthcare provider also should talk to them about their risk
of sudden unexpected death in epilepsy (SUDEP) and the potential to develop cognitive
problems and other issues, such as depression and anxiety, which are more common in
patients with epilepsy.
“Seizure symptoms can easily go unrecognized and untreated if people don’t know they are at
risk to begin with,” said Dr. Bermeo-Ovalle. “SeLECT is one tool that can be used to assess
risk when they are released from the hospital, so they, their caregivers and their physicians
know what to look for and to seek treatment if needed.”
1. Merkler A, Gialdini G, Lerario M, et al. Population-based assessment of the long-term
risk of seizures in survivors of stroke. Stroke. 2018;49(6):1319-1324.
2. Galovic M, Dohler N, Erdélyi-Canavese B, et al. prediction of late seizures after
ischemic stroke with a novel prognostic model (the SeLECT core): a multivariable
prediction model development and validation study. Lancet Neurol. 2018;17(2):143-