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Russian Military Medical
CASE REPORT Vol. 41 (4) 2022 Academy Reports
408
DOI: https://doi.org/10.17816/rmmar111881
Research Article
Acute symptomatic epileptic seizures and epilepsy

after stroke

1
1
2
1
Mikhail Yu. Prokudin , Olga V. Tikhomirova , Sergey N. Bazilevich , Dmitriy E. Dyskin ,
1, 3
1
Nikolay V. Tsygan , Anna M. Moiseeva , Svetlana S. Prokudina 4
1 Military Medical Academy, Saint Petersburg, Russia;
2
Nikiforov All-Russian Center of Emergency and Radiation Medicine, Saint Petersburg, Russia;
3 B.P. Konstantinov Petersburg Nuclear Physics Institute, National Research Centre “Kurchatov Institute”, Gatchina, Leningrad region, Russia;
4 City polyclinic No. 43, Saint Petersburg, Russia
Acute symptomatic epileptic seizures occur within 7 days after the stroke onset. Acute symptomatic epileptic seizures
occur in 6.3% of stroke cases: ischemic stroke — 4.2%, cerebral infarction with hemorrhagic transformation — 12.5%,
intracerebral hemorrhage — 16.2%. Cumulative risk of subsequent unprovoked epileptic seizure after the first acute
symptomatic seizure at follow-up for 10 years is 18.7 %. In acute symptomatic epileptic seizure secondary prevention with
antiepileptic drugs usually is not indicated. If antiepileptic drug treatment is initiated after a single acute symptomatic sei-
zure, it should be discontinued after the acute period of the disease. The 10-years risk of subsequent unprovoked epileptic
seizures after the single unprovoked epileptic seizure in stroke patients is 71.5%. In this situation the epilepsy diagnosis is
reasonable and antiepileptic drug treatment should be initiated. The incidence of epilepsy after acute ischemic or hemor-
rhagic stroke is identical — 10–12%. The choice of the group of antiepileptic drugs should be based on clinical guidelines
for patients with focal forms of epilepsy. Pharmacokinetic interactions between antiepileptic drugs and oral anticoagulants,
antiplatelet agents, antihypertensive drugs, and other xenobiotics should be minimized. Thus antiepileptic drugs that induce
or inhibit microsomal liver enzymes should also be avoided.
Keywords: acute symptomatic epileptic seizures; antiepileptic drug treatment; cerebral venous thrombosis; epilepsy; stroke;
thrombolysis; unprovoked epileptic seizures.
To cite this article:
Prokudin MYu, Tikhomirova OV, Bazilevich SN, Dyskin DE, Tsygan NV, Moiseeva AM, Prokudina SS. Acute symptomatic epileptic seizures and epilepsy
after stroke. Russian Military Medical Academy Reports. 2022;41(4):407–413. DOI: https://doi.org/10.17816/rmmar111881

Received: 12.10.2022 Accepted: 18.10.2022 Published: 17.11.2022

The article can be used under the CC BY-NC-ND 4.0 license
© Authors, 2022