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Seizures After a Stroke

By Walt Kilcullen

 

 

Many people without stroke knowledge mistake a seizure for a stroke because they can look the same as they occur. Strokes and Seizures should not be confused. They are vastly different. A seizure is usually brief and the person recovers after a short time. A stroke is a longer episode and almost always leaves some kind of permanent damage.

 

Joan Lippert, Managing Editor of Publications at Albert Einstein College of Medicine, explains the difference between stroke and seizure. “A seizure happens when a brief, strong surge of electrical activity affects part or all of the brain. Nerve cells in your brain conduct the electricity. Cells that are chemically or physically unstable may become too active, conduct too much electricity, and activate nearby nerves.

 

“A stroke interferes with the brain’s blood supply in one of two ways: When a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot (Ischemic) or bursts (hemorrhagic). In both types of stroke, the surrounding area of the brain can’t get the blood and oxygen it needs, and it starts to die within two to three minutes.” (“Stroke and Seizure,” Joan Lipper, Heart Insight, May, 2008).

 

But what causes a stroke survivor to experience seizures more commonly than people who have not had a stroke? First some facts.

 

1.

Between 10% and 22% of stroke survivors experience seizures until several years post stroke. (In one article that I read, the authors put the figure at 10%. However, the Epilepsy Foundation puts the number at 22%.)

2.

In the elderly, just over half of newly diagnosed cases of epilepsy are related to a previous stroke.

3.

The Stroke Registry reports that of the approximate 730,000 people who experience strokes each year, about 36,500 will have seizures post stroke.

4.

Seizures post stroke are slightly more apt to happen in cases of hemorrhagic rather than ischemic stroke.

5.

Seizure risk after a stroke is greatest within the first thirty days post stroke.

6.

Seizures become a greater risk after a second stroke.

 

According to Ralph L. Sacco, M.D., professor of neurology and epidemiology at Columbia University Medical Center, “Seizures occur whenever there is a scar on the brain. When stroke injures part of the brain, it leaves a scar, and this scar can then trigger abnormal electrical activity that can start a seizure.” (“Controlling Post-Stroke Seizures,” Mike Mills, Stroke Connection Magazine, January/February, 2006).

 

Treating seizures after a stroke:

 

Although doctors have a good understanding of what causes seizures and how to treat seizures, there is no cure. They do know that treating seizures at early onset, usually with specific medications, will result in decreased risk for recurring seizures. However, there is still risk for long term seizures.

 

Treating seizures post stroke is the same as treating epilepsy. That is, the same drugs are given for both epileptic and post stroke seizures. There are presently 54 anti seizure drugs approved either by the FDA (Food and Drug Administration) or by similar regulators in other countries. These medications can be divided into “narrow-spectrum anti seizure medications,” designed to treat specific types of seizures, and “broad-spectrum anti seizure medications.” designed to treat a wide variety of seizures types.

 

Doctors will prescribe an appropriate medication for a patient and consider side effects to be avoided, convenience of use, cost, insurance coverage, and type of seizure diagnosed.

 

Narrow-spectrum (Brand names)

Broad-spectrum (Brand names)

Dilantin

Depakote

Phenobarbital

Lamictal

Tegretol

Topamax

Trileptal

Zonagran

Neurontin

Keppra

Lyrica

Klonopin

Vimpat

Banzel

Sabril

 

 

Every seizure medication can have side effects. These include fatigue, dizziness, unsteadiness, blurry vision, stomach upset, headaches, reduced resistance from colds, and memory loss. This is just a partial list and these side effects are usually temporary. There are, however, some rare but serious side effects that can occur.

 

These include problems with blood count, depression with suicidal thoughts, and possible liver damage. Each individual drug will come with a package insert to list that drug’s possible side effects. It is important for patients taking an anti-seizure drug to read that insert carefully.

 

And finally, I mention different kinds of seizures in the paragraph above just before the listing of drugs. If you would like to know more about types of seizures, you can get a complete yet simple explanation from, Neurology Now, August/September, 2013, p. 45.

 

 

You can reach Walt at wkilcullen@strokenetwork.org.

 

 

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