Epilepsy after stroke: what are the treatment options?

July 13, 2018

After experiencing a stroke, life changes… a lot. And for roughly 7% of stroke survivors, post-stroke epilepsy (PSE) is the challenge they face. Unfortunately, only limited treatment options for the condition exist. That’s why researchers from Japan decided to look into this topic. They reviewed the current PSE knowledge looking at the latest data on risk factors and treatment.

Primary vs. secondary treatment for epilepsy after stroke

If a stroke survivor experiences a seizure, physicians will typically prescribe antiepileptic drugs (AEDs) to prevent further seizures from occurring. However, it is unclear at this time if this is the best treatment option. For example, would a more aggressive preventative approach stop PSE from happening in the first place? This article outlines a review of the current understanding of PSE treatment methods for both primary and secondary treatment.

We can look at two categories of preventative treatment for PSE: primary and secondary. Primary treatment methods reduce chances of a first seizure after stroke, and secondary treatment methods aim to prevent further events once a stroke survivor already sustained their first seizure.

The American Heart Association guidelines recommend that physicians should not use AEDs purely to prevent a seizure following a stroke. This is due to the lack of sufficient research telling us what their effects might be when used in this manner. The authors of this review point out, however, that previous research used older-generation AEDs and that more research can test the use of newer generation AEDs for the prevention of PSE.

Newer generation drugs show promise for prevention of PSE

So far, much of what we know about the newer generation of AEDs comes from animal studies. Levetiracetam and Perampanel have both stopped the development of epilepsy in several recent animal studies. Both drugs work by blocking a transmitter in the brain which, in turn, stabilizes the brain’s activity. This prevents the nerve cells in the brain from being too active and, therefore, averts a seizure.

In several studies that used post-stroke patients, statins (the drugs commonly used to treat high cholesterol) have been shown to reduce the risk of PSE as well.

Regarding secondary PSE treatment, this review points out that there is a consensus among physicians. They believe that AEDs can help a patient with multiple seizures post-stroke. But there is not a clear answer on which type of AEDs is best for secondary prevention. Phenytoin and Gabapentin are the most common prescription drugs in the United States. In Europe, Carbamazepine and Gabapentin are the top choices.

What puts a stroke survivor at higher risk for PSE?

Understanding risk factors for PSE could assist physicians with prescribing preventative treatment to those patients at the highest risk and reducing the incidence of a first seizure from occurring after a stroke. This review identified a small number of predictors. According to this paper, the location of the stroke influences PSE occurrence. As well, hemorrhagic stroke is a more likely predictor of PSE than ischemic stroke.

This review makes the need for more rigorous research clear. Further research can study the specific effects of certain drugs in post-stroke epilepsy. Knowing that epilepsy after stroke can negatively impact a patient’s prognosis, it is essential for physicians to treat their patients with the risk of PSE in mind and to have a greater understanding of the best treatment methods.

The lead author of this study is Tomotaka Tanaka, Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.

Editorial note:

New drugs are being tested to prevent the development of epilepsy.

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