Author: Margaret Stafford, MD 12/6/2005
Reviewer: David Thom, MD, PhD
Incidence of seizures and epilepsy in post-stroke patients
• The 1-year risk of seizures in post-stroke patients is 20% in patients with hemorrhagic stroke
and 14% in patients with ischemic stroke.
• Patients with late seizures (occurring >2 weeks after stroke) carry a much higher risk of
• In patients who have had a stroke and no prior history of seizures, what is the incidence of
• Bladin et al. performed a prospective cohort study of stroke patients (Seizures After Stroke
• Population: all patients hospitalized with acute stroke at a group of university teaching
hospitals over 34 months; n=1897.
o Excluded patients with brainstem or cerebellar stroke, subarachnoid or subdural
hematomas, AVMs, and past history of seizures.
• Time-to-event curves showed that 1-year risk of seizures post-stroke was 20% in patients
with hemorrhagic stroke, and 14% in patients with ischemic stroke (p=0.02).
• 60% of seizures were early-onset (within 2 weeks of stroke) and 40% were late-onset (> 2
• Recurrent seizures (epilepsy) were seen in 2.5% of all patients, in 28% of all patients with a
seizure, and in 55% of patients with late onset seizure.
• There were no significant differences in age, gender, or risk factors for stroke of seizure
between seizure and non-seizure groups
• In patients with ischemic stroke, significant risk factors for seizures were cortical location of
infarction and level of disability. In patients with hemorrhagic stroke, only cortical location
was significant to predict seizures.
• Patients with late-onset (> 2 weeks post-stroke) seizures were at greater risk of developing
epilepsy than patients with early onset-seizures(hazard ratio = 23.77, p<0.001).
• The patients in this study were admitted to tertiary care facilities (university hospitals with
stroke units). It is possible that such patients may be more likely to have post-stroke
seizures than stroke patients in the general population
Bladin CF, Alexandrov AV, Bellavance AB, et al. Seizures after stroke: a prospective multicenter
study. Arch Neurology 2000;57:1617-1622.