Update on current knowledge on poststroke epilepsy

Abstract

Background: The main cause of seizures in adults beyond the age of 60s is represented by cerebrovascular diseases, mainly hemorrhagic and ischemic strokes. Poststroke epilepsy (PSE) is one of their complications, that leads to poorer quality of life, higher mortality, greater health expenditures and affecting the functional recovery after stroke. The aim of the study was to identify the factors involved in the occurrence of epileptic seizures after stroke and to summarize them in order to identify potential biomarkers of PSE. A literature review was initiated, based on the following keywords: “epilepsy”, “stroke”, “poststroke seizures”, ”poststroke epilepsy” which were searched on PubMed database. The following filters were applied: publication date – 5 years, species – humans, age of subjects – 18+, language – English. 320 results were identified, from which only Meta-analyses (1), Reviews (18) and Systematic Reviews (4) were analyzed (total – 23 papers). Studies report an overall incidence of early post-ischemic stroke seizures ranging from 2% to 33%, while that of late seizures spans from 3 to 67%. Seizure activity is identified in up to 8 – 13% of patients following intracerebral hemorrhage. In recent years, more studies started to evaluate blood biomarkers associated with the occurrence of PSE leading to the hypothesis that they are more accurate for the prognostic of PSE. Conclusions: Diagnosis of PSE is often challenging because of the diversity of clinical manifestations. However, there are no reliable guidelines in clinical practice regarding most of the fundamental issues of PSE management.