Seizures and Epilepsy

In the first few weeks following a stroke some stroke survivors will experience a seizure. Seizures are a sign of brain injury and are caused by sudden disorganized electrical activity in the brain. Seizures can be characterized by spasms or convulsions. Stroke is the most common cause of seizures in older people.

Around 5% of people who have a stroke will have a seizure within a few weeks of having a stroke. It is difficult to predict which stroke survivors will have a seizure. Acute or onset seizures normally happen within 24 hours of the stroke. You are more likely to have one if you have had a severe stroke, a stroke caused by bleeding in the brain (a hemorrhagic stroke), or a stroke involving the part of the brain called the cerebral cortex.

If you have an onset seizure, it does not necessarily mean you have or will develop epilepsy. Your risk of having a seizure lessens with time following your stroke. A small number of people will have more than one seizure and will develop epilepsy. If you have recovered and have not yet had a seizure, you are at very low risk of developing epilepsy.

There are over 40 different types of seizures ranging from tingling sensations or ‘going blank’ for a few seconds, to shaking and losing consciousness. Generalized seizures are the most common and dramatic type of seizure and are caused by electrical pulses on both sides of the brain. Partial seizures or focal seizures occur in only one part of the brain. These are common to individuals with epilepsy.

Occasionally, a stroke survivor may suffer from chronic and recurring seizures as a result of stroke and may be diagnosed with epilepsy. Many stroke survivors who experience seizures do not develop epilepsy. If you have seizures a month or more after your stroke, you are more at risk for epilepsy.

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.

Luckily, stroke-related epilepsy can typically be fully controlled with anti-seizure medicines. Taking medications regularly as prescribed is very important in post-stroke seizure management.

A device called a vagus nerve stimulator (VNS), also known as “a pacemaker for the brain,” is a battery-powered device that can be surgically attached to your vagus nerve in your lower neck. The VNS simulates your nerve with pulses of electrical energy and can help prevent future seizures. You usually continue to take medication while using the device. If medications do not effectively control your seizures/epilepsy, surgery may be an option.

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

If you seek treatment for seizures you should have a long, enjoyable life with a few adaptations. Seizures and epilepsy can restrict your independence by limiting your 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. Avoid dehydration, overexertion and hypoglycemia as this can help you 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 your needs.

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