A stroke occurs when blood flow to a part of the brain is disrupted, either by a blockage or bleeding, causing brain cells to die. This sudden event can lead to lasting brain damage and is a leading cause of disability. A potential complication that can arise after a stroke is the occurrence of seizures, known as post-stroke seizures.
Understanding Post-Stroke Seizures
Post-stroke seizures (PSS) are abnormal bursts of electrical activity in the brain, caused by the damage inflicted by the stroke. When brain tissue is injured, it can disrupt the normal electrical signals between nerve cells, leading to these uncontrolled electrical discharges.
PSS are broadly categorized based on their timing relative to the stroke event. Early-onset seizures typically occur within the first week following a stroke. These are considered acute symptomatic seizures, directly provoked by the immediate brain injury, inflammation, or swelling.
In contrast, late-onset seizures develop more than a week after the stroke, sometimes months or even years later. The incidence of PSS varies, with approximately 5% to 20% of stroke survivors experiencing them.
Do Post-Stroke Seizures Resolve?
Whether post-stroke seizures resolve completely varies significantly among individuals. Early-onset seizures may often be isolated events and do not necessarily indicate a tendency for recurrent seizures. However, these early seizures can sometimes increase the risk for later seizures.
Late-onset seizures are more likely to lead to a diagnosis of epilepsy, which is characterized by recurrent, unprovoked seizures. These often require ongoing management.
Several factors influence the likelihood of PSS resolution and the development of epilepsy. Strokes involving the brain’s outer layer (cerebral cortex), larger or more severe strokes, and hemorrhagic strokes (caused by bleeding) are associated with a higher risk of seizures. The presence of scar tissue and ongoing changes in the brain’s electrical activity due to stroke damage also play a role. For many, “going away” often refers to effective control and management through treatment, rather than a spontaneous disappearance of seizures.
Managing Post-Stroke Seizures
The management of post-stroke seizures begins with accurate diagnosis by a healthcare professional. Electroencephalography (EEG), which records brain activity, is a valuable tool for identifying seizure patterns.
The primary treatment approach usually involves anti-seizure medications (ASMs), also known as anticonvulsants. These medications aim to control seizure activity and reduce their frequency. Newer generation ASMs, such as lamotrigine and levetiracetam, are often considered due to their effectiveness and generally fewer drug interactions, a key consideration for stroke survivors taking other medications.
Beyond medication, lifestyle adjustments can also contribute to seizure management. Maintaining proper hydration, avoiding overexertion, and identifying and avoiding specific triggers are often recommended. Regular medical follow-up and strict adherence to the prescribed treatment plan are important for effective seizure control. Prophylactic use of ASMs to prevent a first seizure after stroke is generally not recommended, except in very high-risk situations like severe hemorrhagic stroke.
Long-Term Outlook and Support
Individuals experiencing post-stroke seizures often require ongoing medical care and monitoring to manage their condition. Seizures can impact daily life, potentially leading to increased disability, cognitive changes, and longer hospital stays. Continuous medical oversight helps adjust treatments and address emerging concerns.
Support systems play an important role in navigating the long-term implications of post-stroke seizures. Family, caregivers, and patient advocacy groups can provide valuable assistance and resources.
Individuals should seek immediate medical attention if a seizure lasts longer than five minutes, if seizures occur repeatedly without recovery in between, or if an injury results from a seizure. A seizure lasting over five minutes or recurring without full recovery is a medical emergency known as status epilepticus. While some post-stroke seizures may resolve, effective management allows many individuals to lead fulfilling lives.