Although more individuals are surviving strokes and getting timely treatment, there is a higher risk of developing epilepsy. With this, the requirement to recognize the subtle symptoms of seizures becomes crucial.
“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, MD, 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 proactive.”
A study (NCT02446587) demonstrates that an instrument, called SeLECT, can help predict who is at highest risk, based on 5 factors, which are each assigned points: severity of stroke (0-3); large-vessel occlusion (LVO) (0 or 1); seizures in the first week poststroke (0 or 1); stroke involving the cortex (0 or 3); and stroke caused by a blockage in the middle cerebral artery (MCA) (0 or 1). Individuals receive a score from 0 to 9. Researchers tested the instrument in 1,169 people from 3 international studies and found that, among those determined by the instrument to be at the highest risk (9 points), 63% and 83% developed seizures within 1 and 5 year(s), respectively. Among those at the lowest risk (0 points), 0.7% developed seizures within one year and 1.3% developed seizures within 5 years.
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 if necessary. If these tests are positive, antiseizure medications (ASMs) should be used..
Treatment to prevent the development of epilepsy is not yet available but it is 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 health care 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 individuals with epilepsy.
Thomas P. Leist, MD
Evanthia Bernitsas, MD
Michael V. Robers, MD, Deepak Soneji, MD, PhD, and Lilyana Amezcua, MD, MS