Post – Stroke Seizures: A Comprehensive Review of Epidemiology, Pathophysiology, Risk Factors, Clinical Spectrum and Outcomes

Post – stroke seizure (PSS) represent a significant and often notable complication following cerebrovascular damage due to infarct and hemorrhage, that can affect stroke recovery and the long-term prognosis. This review aims to delineate the epidemiology, clinical spectrum, and outcomes of PSS through an extensive analysis of current literature. It is classified into two types based on the onset of occurrence following stroke, early-onset, occurring within the first seven days following stroke, and late-onset, which manifest beyond seven days after stroke. Early seizures have the same clinical course as acute symptomatic seizures, they rarely recur or require long – term antiepileptic drugs (AED’s). Conversely, late seizures are associated with a risk of recurrence similar to that of unprovoked seizures in a patient with a focal lesion, thereby requiring long – term administration of AED’s. The pathophysiology of PSS is multifaceted and involves a complex interplay of acute metabolic disturbances, excitotoxic neurotransmitter release causing neuronal hyperexcitability, and chronic neural network reorganization. Key risk factors include the type, location, and severity of the stroke, with cortical and hemorrhagic strokes being more prone to induce seizures. Clinically, PSS manifests predominantly as focal seizures, with some cases progressing to generalized seizures or status epilepticus. PSS is associated with poorer functional recovery, reduced quality of life, cognitive decline, increased morbidity, and a higher risk of developing epilepsy. Preventing stroke and PSS remains a cornerstone of any strategy to achieve optimal brain health. Early identification and appropriate management of PSS are crucial for minimizing their impact and thereby improving long – term outcomes for stroke survivors. Effective management includes the use of AED’s, secondary prevention strategies, comprehensive rehabilitation, and regular monitoring. Continued research and individualized treatment plans are essential to develop better preventive, diagnostic, and therapeutic strategies for PSS, ultimately enhancing the prognosis and wellbeing of those affected by strokes.