Are epileptic fits possible after a stroke?

Interview with Professor Nicolas Gaspard, Head of the Department of Neurology at the H.U.B

When suffering a stroke or when a loved one suffers one, the initial urgency is survival, recovery and rehabilitation. But several weeks or months later some patients face an unexpected phenomenon:  epileptic seizures when they have never had one previously. This can be surprising, worrying and sometimes misinterpreted. This article is to help you understand  what is happening without over-dramatising it.  

1. Why can an epileptic seizure occur after a stroke?

A stroke leaves a small scar in the brain. In approximately 1 in 10 patients this scar becomes the point of departure for epileptic seizures. This has nothing to do with any seizures experienced on the day of the stroke as the latter are caused by the acute event whereas epilepsy is a disease that develops over time. 

“This phenomenon is not rare, especially when the stroke has been severe or in the case of a haemorrhagic stroke,” explains Professor Gaspard.

2. And if the person was already epileptic?

“This is a much less common situation. A stroke does not usually change the nature of a pre-existing epilepsy. But in persons aged over 65, an epilepsy of vascular origin (related to the blood vessels) is very common,”    explains Professor Gaspard.

In other words: when an elderly person starts having epileptic seizures it could be a sign that they are at risk of a stroke. In these cases the doctors put into place a policy of strict prevention, as if it were a first stroke. 

3. What are the warning signs after a stroke?  

Epileptic seizures can take many different forms. They do not always resemble “conventional” convulsions. The following should cause you to see a doctor quickly:  

• Loss of consciousness, even briefly;
• Involuntary shaking;
• Sudden speech difficulty;

These can resemble a further stroke, which means there is even more reason for concern. If in doubt  call 112 or the Stroke Unit at the H.U.B.

4. How is a diagnosis made?

In most cases it is the account given by the patient or those close to them that is most helpful.  A recording of the brain activity (electroencephalogram - EEG) can show any anomalies but not always.  

“Whatever the result, doctors make their diagnosis above all on the basis of what you describe to them,”  stresses Professor Gaspard.

5. Effective treatment

The good news is that stroke-related epilepsies respond very well to treatment: The vast majority of patients experience no further seizure  if they take the right medication. In deciding the treatment, doctors take into account:  

• Age;
• Memory and concentration (some medication can affect them);  
• Other treatment already followed.

6. How to reduce the risk of further seizures?

A few simple practices can make a real difference:

• Adhere strictly to the treatment, every day;
• Use a dosette box, alarms, or ask a close friend or relative for help in the event of any difficulties;
• Be sure to get regular sleep of good quality;
• Limit alcohol consumption;
• Tell the doctor about any  new medicine  as some may make seizures more likely.