How to diagnose and treat post-stroke seizure and epilepsy

Post-stroke epilepsy (PSE) is an important event after cerebrovascular accidents, treatment options are still limited. While many physicians prescribe antiepileptic drugs (AED) for secondary prevention of PSE, it is unclear which drug is the most effective in control of recurrence of seizures.PSE is divided into early and late seizures. Early seizures occur within the first week after stroke. This is also termed 'acute symptomatic seizures', Late seizures have a peak Incidence of ۶-۱۲ months after stroke.There are some consequences after stroke that are etiologies of PSE, including: hypoxia,metabolic dysfunction, global hypoperfusion, hyperperfusion, glutamate excitotoxicity, ion channel dysfunction and BBB disruption in the acute phase. Above factors leading to early seizure.Gliotic scarring, chronic inflammation, angiogenesis, neurodegeneration, neurogenesis, axonal and synaptic sprouting, selective neuronal loss, and altered synaptic plasticity are main suspects as mechanisms of late seizures. Glutamate has been also known to produce epileptiform discharges in surviving neurons. For control and treatment of PSE we should know about the type of PSE. For primary prevention: In clinical studies, LEV was associated with improved outcomes after intracerebral hemorrhage. Aspirin and statins have been reported to a has role in preventing epileptogenesis and may also be effective for PSE.For Secondary prevention it is uncertain which AED are the most effective for the prevention of recurrence of seizure. According to ILAE report CBZ, LEV, PHT, zonisamide (ZNS) are approved as an initial monotherapy in adults with PSE.Second generation drugs may be considered because of the lower incidence of side effects and interactions.In conclusion Physicians should always treat stroke survivors with the risk of PSE in mind.Future studies analysis may also be useful in predicting who will develop PSE.