What is a post-stroke seizure?
Stroke: A stroke occurs when there is a disruption in blood flow to the brain, either due to a blockage (ischemic stroke) or bleeding (hemorrhagic stroke). This interruption can lead to brain damage and loss of function. Stroke is one of the leading causes of seizures and epilepsy in older adults, particularly in individuals over the age of 45.
Seizure: A seizure is a sudden, abnormal surge of electrical activity in the brain. This can result in changes in consciousness, behavior, sensation, memory, or movement. Seizures can occur following both ischemic and hemorrhagic strokes.
Epilepsy: A condition characterized by two or more unprovoked seizures occurring more than 24 hours apart.
Post-stroke seizures are associated with a decline in quality of life, longer hospital stays, and increased mortality.
How are post-stroke seizures classified ?
Post-stroke seizures are typically categorized into two types:
- Early-onset seizures: Occur within 24 hours of the stroke.
- Late-onset seizures: Occur between 6 to 12 months after the stroke.
What are the Risk Factors for post-stroke seizures?
Some of the known risk factors include:
- Greater stroke severity (as measured by the NIH Stroke Scale)
- Male gender
- Hemorrhagic stroke
- Cortical involvement
- Younger age within the older adult population
What are the common signs of a post-stroke seizure ?
1. Changes in Awareness
- Blank staring or “spacing out”
- Confusion or not making sense when speaking
- Loss of consciousness (passing out)
2. Movements You Can See
- Jerking or shaking in the arm, leg, or face (often on one side)
- Repetitive movements (like lip-smacking or hand rubbing)
- Sudden stiffness or weakness
3. Feelings or Sensations
- Tingling or numbness
- Seeing flashing lights or blurred vision
- Hearing buzzing or strange sounds
4. Mood or Behavior Changes
- Sudden fear or anxiety
- Crying or laughing without reason
- Acting differently or out of character
5. After the Seizure (Post-Seizure Phase)
- Feeling very tired or sleepy
- Headache
- Trouble speaking or thinking clearly
- Weakness (especially on one side)
How is a post-stroke seizure diagnosed ?
A post-stroke seizure is diagnosed through a combination of medical history, neurological evaluation, and diagnostic tests. Here’s how doctors typically approach it:
🧠 1. Medical History & Symptom Description
- The doctor will ask about:
- The type of stroke (ischemic or hemorrhagic).
- When the seizure occurred relative to the stroke.
- What happened during the episode—movements, duration, confusion, memory loss, etc.
- Any previous seizures or known epilepsy.
🩺 2. Neurological Exam
- To check for signs of brain dysfunction or damage, such as weakness, confusion, or speech issues.
- Helps differentiate between seizure symptoms and stroke-related deficits.
⚡ 3. EEG (Electroencephalogram)
- Records brain’s electrical activity.
- Can detect abnormal brain wave patterns linked to seizures or epilepsy.
- Helpful for confirming if seizure activity is ongoing or intermittent (especially if subtle).
🧪 4. Blood Tests
- Rule out other seizure triggers like:
- Low blood sugar
- Electrolyte imbalances
- Infections
🧍♂️🧍♀️ 5. Brain Imaging
- CT Scan or MRI to:
- Confirm stroke type/location.
- Detect bleeding, swelling, or new damage.
- Rule out tumors or infections that might mimic seizures.
📅 Timing Matters
- Early-onset seizure = occurs within 1 week of stroke.
- Late-onset seizure = occurs more than 1 week after stroke, more likely to develop into epilepsy.
What is the treatment for a post-stroke seizure?
Treatment for a post-stroke seizure depends on factors like when the seizure occurred, how often it happens, and the person’s overall health. Here’s a breakdown:
⚕️ 1. Treat the First Seizure (If It’s a One-Time Event)
- If it was a single seizure shortly after a stroke, doctors may not prescribe long-term anti-seizure medication right away.
- Instead, they:
- Monitor the patient closely.
- Look for correctable causes (like infection, low sodium, etc.).
- Use short-term meds if needed during hospitalization.
💊 2. Anti-Seizure Medications (ASMs)
If seizures recur or there’s a high risk of recurrence, doctors will usually start anti-seizure medications like:
- Levetiracetam (Keppra) – commonly used; fewer interactions
- Phenytoin (Dilantin) – older option, sometimes used short-term
- Lamotrigine (Lamictal) or Valproate (Depakote) – used in some cases
✔️ Medication is usually continued for months or years, depending on risk.
🧠 3. Treat Underlying Stroke-Related Issues
- Managing the stroke itself and preventing another one is key:
- Control blood pressure
- Take blood thinners or antiplatelets if prescribed
- Manage cholesterol and blood sugar
- Rehab to improve brain recovery
⚖️ 4. Lifestyle Adjustments
- Avoid known seizure triggers: sleep deprivation, alcohol, stress.
- Stay hydrated and take meds consistently.
- Regular neurologist follow-ups are important.
📅 What If They Develop Epilepsy?
If seizures become chronic, the person may be diagnosed with post-stroke epilepsy and need long-term management just like anyone with epilepsy.
What is the first-aid plan for a post stroke seizure?
Seizures can be scary to witness, but staying calm and knowing what to do can make a big difference.
✅ What to Do During a Seizure
- Stay Calm
- Most seizures stop on their own within 1–2 minutes.
- Protect the Person
- Gently help them lie down on their side (if possible).
- Put something soft (like a folded jacket) under their head.
- Remove nearby sharp or dangerous objects.
- Loosen Tight Clothing
- Especially around the neck (ties, scarves, collars).
- Time the Seizure
- Note how long it lasts and what movements or behaviors you see.
- This information helps doctors later.
- Stay With Them
- Talk to them in a calm voice as they come out of the seizure.
- Reassure them—they may be confused or scared afterward.
❌ What Not to Do
- 🚫 Do NOT hold them down.
- 🚫 Do NOT put anything in their mouth (they won’t swallow their tongue).
- 🚫 Do NOT give food, drink, or medication until they are fully alert.
📞 Call Emergency Services If:
- The seizure lasts more than 5 minutes
- The person doesn’t wake up or return to normal behavior
- They have trouble breathing or turn blue
- Another seizure starts right after the first
- It’s their first-ever seizure
🧩 After the Seizure (Recovery Phase)
- Let them rest—they may feel tired, confused, or emotional.
- Check for injuries (like tongue biting or head bumps).
- Make sure they’re breathing normally.
- Stay with them until they are fully alert.
Here are two posters to further help a patient suffering from a seizure:
Thanks very much to our Stroke Support Group Member Ms Harini Gali for contributing to this article !
In India the common numbers for emergency medical services are 112 or 108 .
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If you have limited/No information about Stroke, its symptoms and consequences, we STRONGLY suggest you read at least one of the following before you leave this Website, as well as share the links with your friends and family. You may save someone from sudden death or being crippled for life !
* Be fast – Stroke Symptoms in English with Videos of Actual Strokes
* स्ट्रोक (आघात) – हिंदी में कुछ जानकारी
* स्ट्रोक-के-साधारण-लक्षण
* In Bengali – Be Fast – দ্রুত !
* In Gujarati – જ્યારે સ્ટ્રોક આવે ત્યારે BE FAST
* In Marathi – BE FAST स्ट्रोक होतो तेव्हा !
* In Odiya – ଷ୍ଟ୍ରୋକ: ମୃତ୍ୟୁ ଅଥବା ଶାରୀରିକ/ମାନସିକ ଅସମର୍ଥ