Post-stroke seizures and epilepsy contribute to a high complication burden in patients with ischemic stroke, according to a systematic review and meta-analysis published in Neurology.
Researchers identified 35 studies that reported stroke-related seizures and 6 studies that evaluated the effects of antiepileptic drugs for the treatment of stroke-related epilepsy. Following a pooled data analysis of the 41 studies, investigators found that early seizure rate was 3.3% following stroke, whereas late seizures or epilepsy was reported at 18 per 1000 person-years (95% CI, 15-22; I2 =92.8%).
Additionally, researchers found that no antiepileptic drug was more effective than any other antiepileptic therapy; however, patients taking newer antiepileptic drugs appeared to experience fewer adverse effects in some studies. Investigators reported on one randomized study that evaluated the effects of antiepileptic therapy among 64 patients with post-stroke seizures and found that more patients receiving lamotrigine compared with carbamazepine were seizure free at 1 year, but this was not found to be statistically significant.
Researchers excluded non-English studies, which may have reduced the robustness of this systematic review. Additionally, the definition of outcomes analyzed in this meta-analysis varied across studies. Despite these inherent limitations, the investigators did differentiate between late and early seizures and used statistical methods that allowed for assessment of all studies in the meta-analysis.
The investigators commented that further research may identify risk factors and response to therapy. They also stated that additional studies to “determine the predictors for development of seizures are needed to identify and target specific interventions in those at high risk.”
Wang JZ, Vyas MV, Saposnik G, Burneo JG. Incidence and management of seizures after ischemic stroke: Systematic review and meta-analysis [published online August 23, 2017]. Neurology. doi:10.1212/WNL.0000000000004407