A seizure is a sudden episode of abnormal or disorganized electric activity in the brain. Stroke is the most common cause of seizures in the aging population and approximately 10 percent of stroke survivors experience a seizure after a stroke. Seizures can be characterized by spasms or convulsions.

Epilepsy is a neurological disorder in which recurrent seizures occur that cannot be associated with other specific causes. Seizures, as well as the onset of epilepsy, can occur after a stroke. Having one seizure after a stroke does not necessarily mean a person has epilepsy; however, if chronic and recurring seizures are a result of a stroke, then a stroke survivor may be diagnosed with epilepsy.

When stroke warning signs are not clearly present, a seizure may indicate that a person had a stroke, especially in children and infants.

Symptoms (Incidence)

It is not easy to define all seizures. It is always important to consult with a healthcare professional.

It is difficult to predict which stroke survivors will have a seizure since research on post-stroke seizures varies widely. Two to 33 percent of stroke survivors who had an ischemic stroke will experience a seizure. Additionally, seizures are more serious if they occur shortly after a stroke and stroke survivors who have a hemorrhagic stroke are more likely to have seizures within the first 24 hours. Studies show that people who have a seizure within 24 hours of a stroke have a higher mortality rate, making it essential that everyone knows the signs and symptoms of a seizure.

Two Types of Seizures

Generalized seizures are the most common and dramatic type of seizure and are caused by electrical pulses on both sides of the brain. There are six types of generalized seizures:

Type	Symptoms
Tonic-clonic (Grand-mal)	Muscle stiffness; convulsions; loss of consciousness
Absence (Petit-mal)	Jerking or twitching muscles; staring into space
Tonic	Stiff muscles (usually in back, legs and arms)
Clonic	Repeated jerking movements of muscles on both sides of the body
Myoclonic	Jerks or twitches in upper body, arms or legs
Atonic	Loss of normal muscle tone; person may fall down

Partial seizures or focal seizures occur in only one part of the brain. These are common to individuals with epilepsy. Partial seizures are characterized by the area of the brain where they originate (e.g., focal frontal lobe seizures).

Type	Symptoms
Simple Focal	Sudden sensations: emotional (anger, joy or nausea) or sensory (sight, taste, smell, hearing) but the person retains consciousness
Complex Focal	Change or loss of consciousness; person may exhibit strange behaviors such as walking in circles, performing repetitive movements, blinking or twitching

Many stroke survivors who experience seizures do not develop epilepsy; however, stroke survivors with seizures a month or more after a stroke are more at risk for epilepsy.

Treatment

Medication

Taking medications regularly as prescribed is very important in post-stroke seizure management.

Antiepileptic drugs (AEDs) are the most common treatment for preventing seizures and managing epilepsy for people of all ages. AEDs are also referred to as anticonvulsants and effectively control seizures in roughly 88 percent of patients. Stroke survivors with recurring seizures and epilepsy are generally treated with AEDs. Unfortunately, there are studies that show that the administration of some common AEDs can be harmful to stroke recovery. Therefore, AED treatment is not always used after an early post-stroke seizure or for treatment of the first seizure.

Consult with a healthcare professional to find the treatment that works best for you.

Surgery

If medications do not effectively control seizures/epilepsy, surgery may be an option for people who have focal seizures. The American Academy of Neurology recommends surgery for people with temporal lobe focal seizures if antiepileptic drugs are ineffective.

Depending on the type and location of the seizure, a surgeon may:

Remove the area of the brain that causes the seizure (lobectomy or lesionectomy).
Make a series of cuts in the area that causes the seizure to prevent seizures from spreading to other parts of the brain (multiple subpial transection).
Sever neuron connections between the two halves of the brain to prevent seizures from spreading (corpus callosotomy).
Remove half of the brain’s cortex, or outer layer (hemispherectomy or hemispherotomy).

Devices

The vagus nerve stimulator (VNS), also known as “a pacemaker for the brain,” is a battery-powered device that can be surgically attached to the vagus nerve in the lower neck. The VNS simulates the nerve with pulses of electrical energy and can help prevent future seizures. Patients usually continue to take medication while using the device.

Management

Stroke survivors who seek treatment for seizures can have a long, enjoyable life with a few adaptations. Seizures and epilepsy can restrict a person’s independence by limiting his or her ability to drive a car. Staying active with regular exercise has been shown to help with seizure control as long as appropriate safety precautions are taken. Avoiding dehydration, overexertion and hypoglycemia can help stroke survivors stay active without raising the risk of seizures. Some activities such as cooking or swimming, may require supervision. Consult with a healthcare professional on specific management tips that meet individual needs.

It is important to let people know if you or a loved one experiences seizures or epilepsy. Educating friends, family, caregivers and co-workers on what to do if the stroke survivor has a seizure is the first step to avoiding injury during a seizure.

If someone has a seizure…

The National Institutes of Health has established guidelines for what to do if someone is having a seizure.

Roll the person on his or her side to prevent choking or vomiting.
Cushion the person’s head.
Loosen any tight clothing around the neck.
Keep the person’s airway open. If necessary, grip the person’s jaw gently and tilt his or her head back.
Do not restrict the person from moving unless he or she is in danger.
Do not put anything in the person’s mouth, not even medicine or liquid.
Remove any sharp or solid objects that the person might hit during the seizure.
Note how long the seizure lasts and what symptoms occurred in order to inform a doctor or emergency personnel if necessary.
Stay with the person until the seizure ends.