Post-stroke epilepsy: From clinical predictors to possible mechanisms

Sofia Freiman; W Allen Hauser; Flora Rider; Natalia Gulyaeva; Alla Guekht

doi:10.1016/j.eplepsyres.2023.107282

Post-stroke epilepsy: From clinical predictors to possible mechanisms

Epilepsy Res. 2024 Jan:199:107282. doi: 10.1016/j.eplepsyres.2023.107282. Epub 2023 Dec 15.

Authors

Sofia Freiman¹, W Allen Hauser², Flora Rider³, Natalia Gulyaeva⁴, Alla Guekht⁵

Affiliations

¹ Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation. Electronic address: ferratino@gmail.com.
² Gertrude H. Sergievsky Center, College of Physicians and Surgeons, New York, USA.
³ Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation.
⁴ Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation.
⁵ Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Buyanov City Hospital of the Healthcare Department of Moscow, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Moscow, Russian Federation.

PMID: 38134643
DOI: 10.1016/j.eplepsyres.2023.107282

Abstract

Background: Stroke is the most common cause of newly diagnosed epilepsy in the elderly, ahead of degenerative disorders, brain tumors, and head trauma. Stroke accounts for 30-50% of unprovoked seizures in patients aged ≥ 60 years. This review discusses the current understanding of epidemiology, risk factors, mechanisms, prevention, and treatment opportunities for post-stroke epilepsy (PSE).

Methods: We performed a literature search in the PubMed and Cochrane Library databases. The keywords "stroke, epilepsy", "stroke, seizure", "post-stroke seizure", "post-stroke epilepsy" were used to identify the clinical and experimental articles on PSE. All resulting titles and abstracts were evaluated, and any relevant article was considered. The reference lists of all selected papers and reference lists of selected review papers were manually analyzed to find other potentially eligible articles.

Results: PSE occurs in about 6% of stroke patients within several years after the event. The main risk factors are cortical lesion, initial stroke severity, young age and seizures in acute stroke period (early seizures, ES). Other risk factors, such as a cardioembolic mechanism or circulation territory involvement, remain debated. The role of ES as a risk factor of PSE could be underestimated especially in young age. Mechanism of epileptogenesis may involve gliosis scarring, alteration in synaptic plasticity, etc.; and ES may enhance these processes. Statins especially in the acute period of stroke are possible agents for PSE prevention presumably due to their anticonvulsant and neuroprotection effects. Antiepileptic drugs (AED) monotherapy is enough for seizure prevention in most cases of PSE; but no evidence was found for its efficiency against epileptic foci formation. The growing interest in PSE has led to a notable increase in the number of published articles each year. To aid in navigating this expanding body of literature, several tables are included in the manuscript.

Conclusion: Further studies are needed for better understanding of the pathophysiology of PSE and searching the prevention strategies.

Keywords: Antiepileptic drugs; Epilepsy; Post-stroke seizures; Risk factors; Statins; Stroke.

Publication types

Review

MeSH terms

Aged
Anticonvulsants / therapeutic use
Epilepsy* / drug therapy
Epilepsy* / etiology
Epilepsy* / physiopathology
Humans
Risk Factors
Seizures / etiology
Seizures / prevention & control
Stroke* / complications

Substances

Anticonvulsants