Vascular (post-stroke) epilepsy

What triggers an epileptic seizure after a stroke?

Relatively recently, WHO announced a trend towards a gradual increase, in percentage terms, in the number of patients in whom epileptic disease developed against the background of a pre- or post-stroke state.

It is generally accepted that the main reason for the development of epileptic seizures after a stroke is the age of the patient, or rather the inability of the aging body to cope with the consequences of acute cerebral blood supply.

The process of development of epileptic seizures is as follows:

Onset – as a result of various pathological conditions, vascular disorders and injuries, the patient’s blood flow intensity decreases.
Development - constant oxygen starvation causes the development of coronary artery disease, and also manifests itself in motor twitching - the first warning signs indicating a pre-stroke condition. The symptoms are partial, i.e. indicates the location of brain damage.
The bottom line is that epilepsy and ischemic stroke are interrelated. The first seizures after an attack occur in the first seven days and are associated with metabolic changes that occur as a result of ischemic brain damage.

The provoking factor of post-stroke epilepsy is acute ischemic damage to nerve tissue, extensive hemorrhagic damage (more than one lobe) of the brain.

Epilepsy after stroke: prognosis for recovery after epileptic seizures

There are often cases when, after suffering an ischemic or hemorrhagic stroke, a person begins to have epileptic seizures. They can appear for several reasons.

Seizures are a consequence of acute vascular insufficiency. Statistics say that chronic epilepsy after a cerebral hemorrhage develops in 4-5%. This article will focus specifically on these attacks.

Causes

Epilepsy is a disease that occurs due to metabolic disorders in the brain. As a result, the nervous tissue becomes hyperexcitable: a strong discharge easily occurs in it, leading to an attack.

Reference! Scientists consider epilepsy to be a hereditary disease. The likelihood of getting sick increases if there are relatives in the family with a similar problem.

The following factors also increase the chance of developing seizures:

head injuries;
complications during childbirth;
hormonal imbalance;
frequent stress;
non-compliance with the work and rest regime.

Often the disease is not independent.

It can serve as a symptom of other ailments.

These include meningitis, vascular pathologies, and poisoning with various substances.

It is customary to distinguish three main groups of attacks:

Harbingers. They can occur months or even years immediately before the stroke itself. Their appearance is associated primarily with chronic vascular pathology.
Early. Occurs in the first week after a stroke. According to statistics, such attacks account for 25% of all seizures.
Late. They are fixed at least a week after an acute imbalance of normal blood flow. Sometimes the rate of post-stroke seizures reaches 70%. They can happen one or several times.

Frequency of development of epileptic seizures

After a stroke, the frequency of attacks varies depending on the person's age. In young children the figure does not exceed 2%. In school-age children it is fixed at 5%. When it comes to older people, the incidence of epilepsy reaches 20-30%.

In 2.5% of patients, seizures occur within the first six months after a stroke. Older men are more susceptible to the disease than others, since they have atherosclerosis, a tendency to smoke, and an increased concentration of fats in the blood.

How does the disease manifest itself?

All types of attacks are characterized by suddenness.

A few days before the attack, the patient may begin to complain of lack of sleep, headache, poor appetite, and constant fatigue.

Usually the attack goes like this:

a man screams and falls sharply;
he begins to have convulsions;
Random urination is often observed;
the patient’s breathing is disrupted, most of it becomes intermittent, and the pressure in the chest increases;
if the case is classified as special, the tongue sinks in and liquid foam pours out of the mouth.

In this case, it is important to be able to provide first aid to the patient. If he still manages to fall, you need to put a cushion of clothing or a regular pillow under your head. You also need to make sure that the patient does not accidentally bite through his own tongue. At the same time, the clothes should not press on him: it is better to loosen the tie, and unbutton the collar button.

Sometimes an attack occurs while eating. Then it is recommended to remove food from the mouth by any means. In case of intermittent breathing or vomiting, it is better to turn the patient on his side. When convulsions are observed, the following steps should not be taken:

perform artificial respiration;
heart massage;
hold limbs;
open the patient's mouth;
delay in calling doctors.

Unprofessional help can only harm the victim.

How dangerous is this?

If secondary epilepsy is detected, then some complications are possible, since the body is already weakened.

The first seven days after an ischemic stroke occur are considered the most difficult in medical practice

Consequences of early epilepsy:

loss of consciousness;
a person may fall into a prolonged coma;
breathing problems, as a person often accidentally swallows his tongue;
pathologies of internal organs.

Important! Seizures after a stroke do not always indicate epilepsy. In this regard, diagnosis is necessary.

Treatment methods

Treatment of epileptic seizures in pensioners may seem much more difficult than at a young age. The thing is that the latter experience massive changes in the body, people’s cognitive abilities decline, and the risk of osteoporosis increases.

Basic principles of treatment:

It is recommended not to start taking seizure-inducing drugs. The classic example here is Eufliin, but from a theoretical point of view, other medications taken for metabolic and vascular disorders can also provoke an attack;
First of all, it is necessary to treat the stroke itself and somatic illnesses, since epilepsy is fraught with cerebral edema, displacement of the structures of the main organ of the central nervous system, decreased blood glucose levels, and intoxication;
antivascular treatment is carried out. If the patient is conscious, doctors can prescribe medications in tablet form. When the swallowing reflex is impaired, one has to resort to intramuscular injections or administration of drugs through a probe. The symptoms of an attack are relieved by Delakin, Levetiam, Propoflol.

Important! Only complex drug treatment can relieve a patient from seizures. It is prescribed exclusively by a doctor.

The drugs are prescribed by a specialist because they have a number of side effects. They need to be used:

people who have had early attacks;
those who cannot recover from a coma;
patients with active seizures;
those who have been diagnosed with an extensive form of stroke, since the death of the patient cannot be excluded.

It is worth noting that, by and large, it is not ordinary convulsions that pose a threat to life, but powerful discharges occurring in the cerebral cortex. Epilepsy attacks significantly worsen the clinical picture of the disease. Negative consequences include a difficult recovery period and the appearance of new seizures.

Prognosis for recovery

Changing your diet will help reduce the frequency of attacks.

To do this, you must adhere to the following rules:

stop eating meat , that is, adhere to the concept of vegetarianism;
priority should be given to dairy and plant products;
the patient needs to stop smoking ;
You should try to add less salt or avoid it altogether;
Spinach should be included in your diet .

Wormwood, from which it is suggested to prepare a decoction, will help to get rid of and prevent epilepsy attacks. To do this, take three tablespoons of the plant in dry form and a liter of boiled water. The whole mixture is simmered over low heat, then covered with a lid and infused. Twice before meals you need to drink half a standard-sized glass of the decoction.

Surgery will help stop the attacks completely, but this method is an extreme option. A generator is inserted under the patient's skin, which stimulates the vagus nerve through impulses.

Important! The operation is not always possible, since the effect of it may be worse than the epileptic seizures themselves.

Statistical information shows that 70% of patients can be cured of epilepsy with properly selected complex treatment. If attacks do not bother a person for three years, he is considered to have fully recovered.

on this topic:

conclusions

Thus, epilepsy after a stroke is not a death sentence. Modern medicine has learned to deal with these types of attacks, so their frequency and intensity are reduced with the right approach. It is important to recognize a seizure in time and provide first aid correctly to avoid death.

Source: https://doktor-ok.com/zabolevaniya/golovnogo-mozga/insult/epilepsiya.html

How do post-stroke epilepsy attacks occur?

The first signs of epilepsy after a stroke appear a week after the attack. The difference between neurological manifestations is that they lack a visible catalyst factor. Seizures occur unexpectedly.

During the patient's recovery, seizures occur due to cortical atrophy or the development of a cystic formation that irritates healthy and intact tissue.

A late epileptic attack after a stroke can occur several months later, as a result of the development of a tissue scar.

The seizure develops as follows:

Psycho-emotional disorders - the patient experiences a deterioration in his condition: insomnia, loss of appetite, severe headaches, weakness.
Aura – this is the term used by experts to describe the patient’s condition preceding the onset of an attack. Neurologists believe that the sensations before loss of consciousness are individual for each patient. Over time, the patient begins to distinguish between the conditions preceding the seizure.
Loss of consciousness - if the attack cannot be recognized in a timely manner, the patient falls into an unconscious state. Immediately before the seizure, convulsions occur. During an attack, the patient feels pressure in the chest and breathes intermittently with wheezing. In severe cases, foam appears at the mouth and the tongue sinks.

What are the dangers of epilepsy after a stroke and how to get rid of it?

Secondary epilepsy after a stroke develops in 10% of patients suffering from an acute disorder of the blood supply to the brain. In most cases, the development of epileptic seizures is preceded by ischemic disease, provoked by various vascular pathologies.

What triggers an epileptic seizure after a stroke?

The process of development of epileptic seizures is as follows:

Onset – as a result of various pathological conditions, vascular disorders and injuries, the patient’s blood flow intensity decreases.
Development - constant oxygen starvation causes the development of coronary artery disease, and also manifests itself in motor twitching - the first warning signs indicating a pre-stroke condition. The symptoms are partial, i.e. indicates the location of brain damage.
The bottom line is that epilepsy and ischemic stroke are interrelated. The first seizures after an attack occur in the first seven days and are associated with metabolic changes that occur as a result of ischemic brain damage.

The provoking factor of post-stroke epilepsy is acute ischemic damage to nerve tissue, extensive hemorrhagic damage (more than one lobe) of the brain. The nature and intensity of an epileptic attack after a stroke allows us to determine the localization of ischemia, as well as the degree of damage to nerve cells.

How do post-stroke epilepsy attacks occur?

The first signs of epilepsy after a stroke appear a week after the attack. The difference between neurological manifestations is that they lack a visible catalyst factor. Seizures occur unexpectedly.

During the patient's recovery, seizures occur due to cortical atrophy or the development of a cystic formation, which has an irritating effect on healthy and intact tissue. A late epileptic attack after a stroke can occur several months later, as a result of the development of a tissue scar.

The seizure develops as follows:

Psycho-emotional disorders - the patient experiences a deterioration in his condition: insomnia, loss of appetite, severe headaches, weakness.
Aura – this is the term used by experts to describe the patient’s condition preceding the onset of an attack. Neurologists believe that the sensations before loss of consciousness are individual for each patient. Over time, the patient begins to distinguish between the conditions preceding the seizure.
Loss of consciousness - if the attack cannot be recognized in a timely manner, the patient falls into an unconscious state. Immediately before the seizure, convulsions occur. During an attack, the patient feels pressure in the chest and breathes intermittently with wheezing. In severe cases, foam appears at the mouth and the tongue sinks.

A single attack of epilepsy occurring immediately after a stroke does not necessarily indicate the development of a chronic disease. In most patients, neurological symptoms disappear immediately after restoration of the metabolic processes of nerve tissue. Recurrence of epilepsy attacks indicates the development of the disease in a chronic form.

How dangerous are epileptic seizures after a stroke?

Secondary epilepsy, which appears as a result of a stroke, is dangerous due to its complications and negative impact on an already weakened body. The first week after an ischemic attack is considered the most difficult.

If epilepsy develops after a stroke after completing a course of rehabilitation, with the help of drug therapy it is possible to more or less stabilize the patient’s condition.

Among the consequences of post-stroke epilepsy, in the early period, the most dangerous are:

Loss of consciousness – the main danger of post-stroke epilepsy is that the attacks are accompanied by disturbances in the patient’s consciousness. As a result of a seizure, the victim may fall into a coma.
Breathing disorders - during an attack, the patient often swallows his tongue and thus blocks his airways, which often leads to respiratory arrest.
Problems in the functioning of internal organs. Epileptic seizures after a stroke occur because the patient already has various vascular pathologies and blood supply disorders. Seizures make the situation even worse. Neurological manifestations contribute to dysfunction of internal organs.

Convulsive phenomena after a stroke do not always indicate the presence of epilepsy. Therefore, before prescribing a course of therapy, the neurologist will conduct a differential diagnosis.

How to get rid of post-stroke epilepsy seizures

Treating epileptic seizures is quite difficult, even in patients who have not had a stroke. A neurologist is required to understand the mechanisms of disease development.

Before prescribing a course of therapy, a thorough examination of the patient, neurological diagnostics, and an assessment of the body’s condition are carried out.

When treating symptomatic epilepsy with pharmacological agents, it is necessary to take into account the interaction of the prescribed drugs with those that the victim is already taking. Traditional therapy involves the prescription of the following drugs:

Carbamazepine.
Valproic acid preparations.
Convulsofin.
Depakine.

Prescription of Depakine is especially effective in the treatment of elderly people. The drug does not cause cognitive impairment and does not depress respiratory function.

Epilepsy attacks can be stopped with the help of new generation drugs - Lamotrigine, Tiagabine, etc. The prescription of antiepileptic drugs is allowed only after a complete examination of the patient and differential diagnosis. Often the patient experiences convulsive attacks similar to epilepsy, which requires the use of a specific course of therapy.

How to live with post-stroke epilepsy

Epilepsy after a stroke can occur for various reasons, but the main factor in its development remains the patient’s advanced age.

Provided proper rehabilitation measures are carried out, the functions of the brain tissue are gradually restored. The frequency of epileptic seizures decreases, and under favorable circumstances, seizures can stop completely.

Regular use of antiepileptic drugs significantly improves the patient’s quality of life.

Regular consultation with a neurologist and adjustments to eating habits and lifestyle will be required.

It is also recommended to stop drinking alcohol and smoking.

A healthy lifestyle and regular medications will help you adapt to the new condition and lead a relatively normal life.

Source: https://ponchikov.net/522-epilepsiya-posle-insulta.html

How dangerous are epileptic seizures after a stroke?

If epilepsy develops after a stroke after completing a course of rehabilitation, with the help of drug therapy it is possible to more or less stabilize the patient’s condition.

Among the consequences of post-stroke epilepsy, in the early period, the most dangerous are:

Loss of consciousness – the main danger of post-stroke epilepsy is that the attacks are accompanied by disturbances in the patient’s consciousness. As a result of a seizure, the victim may fall into a coma.
Breathing disorders - during an attack, the patient often swallows his tongue and thus blocks his airways, which often leads to respiratory arrest.
Problems in the functioning of internal organs. Epileptic seizures after a stroke occur because the patient already has various vascular pathologies and blood supply disorders. Seizures make the situation even worse. Neurological manifestations contribute to dysfunction of internal organs.

International Neurological Journal 4(14) 2007

In recent years, all developed countries have seen a significant increase in epilepsy in adults (late-onset epilepsy). It has been shown that in elderly patients the primary incidence of epilepsy is 2.5–3 times higher than in other age groups, including children and young adults [18].

Elderly patients have a large number of risk factors for epileptic seizures compared to other age groups due to concomitant cerebral and somatic pathology. Among the most significant identifiable risk factors for late-onset epilepsy, cerebrovascular pathology is detected in 40% of cases. In this regard, it is recommended that all elderly patients with newly diagnosed epilepsy undergo screening to identify risk factors for vascular pathology and select therapy to reduce it [9]. The second important identifiable cause of late-onset epilepsy is dementia, accounting for 11 to 16% of cases [18].

The third leading cause of epilepsy in the elderly is neurosurgical pathology, including brain tumors (4%) and traumatic brain injuries (1 to 3%). Most authors emphasize that the cause of late-onset epilepsy can be the neurosurgical interventions themselves for hematomas, tumors, and intracerebral hemorrhages [13]. C. Kellinghaus et al. (2004) note the difficulties of diagnosing late-onset epilepsy, since focal components (auras), automatisms, atypical absences and unilateral seizures predominate with the development of post-ictal Todd's palsy. All this can be regarded by practitioners as conditions of non-epileptic origin, for example psychomotor agitation, cortical and hemispheric infarctions [13].

On the other hand, A. Zaidi et al. (2000) showed that cardiovascular events can mimic seizure-like conditions. In this case, patients are prescribed anticonvulsants, and doctors mistakenly make a conclusion about the pharmacoresistance of seizures against the background of antiepileptic therapy. Among conditions of vascular origin resembling epileptic seizures, the authors noted bradycardia, hypotension, vasovagal syncope, vasovagal reactions during intravenous injections, heart rate blockade during palpation of the carotid arteries and irritation of the carotid sinus [29]. Therefore, in elderly patients, when diagnosing newly diagnosed post-stroke epilepsy (PSE), a comprehensive cardiac examination is recommended. It was also noted that in elderly patients, post-ictal confusion lasts significantly longer than in young patients and children. In addition, diagnostic difficulties are associated with the difficulty of interpreting interictal interictal EEG. In connection with the above, the problem of late-onset epilepsy is becoming relevant in most developed and developing countries, including Russia, due to the presence of demographic problems and the aging of the population [1].

It is believed that 30–40% of cases of late-onset epilepsy in people over 60 years of age are associated with a stroke [6, 11, 19, 28].

Currently, most countries in the world use the classification of G. Barolin and E. Scherzer (1962), who proposed the division of epileptic seizures in cerebrovascular pathology depending on their onset in relation to the development of stroke [5]. Heralding seizures develop before a stroke in the presence of cerebrovascular disease (CVD) and are a common manifestation of transient cerebrovascular accident (TCI) or a manifestation of the so-called “silent” stroke, which is not accompanied by a pronounced neurological deficit and is subsequently diagnosed retrospectively according to CT data . Early epileptic seizures (early) appear during the first 7 days of stroke development. Late seizures (late), or LSE, imply the development of epileptic seizures 7 days or more after the onset of stroke [1, 4, 8, 15, 16, 25].

Studies conducted in Norway have shown that severe strokes are statistically significant independent predictors (risk factors) of PIE. Currently, using the example of the American population, it has been shown that more than 20 thousand new cases of epilepsy develop in Americans every year. These studies were published in 2005 in the journal Epilepsy [19]. One long-term prospective study involving more than 500 patients showed that the prevalence of PIE was 3.5% in patients with moderate stroke. This study showed that severe strokes increase the risk of developing PIE by 5 times compared with moderate strokes. However, treatment in specialized stroke units, age at onset of primary stroke, and geographic features did not statistically significantly affect the risk of developing epilepsy in this study. At the same time, it was noted that thrombolysis in the acute period of stroke, along with the use of modern neuroprotective drugs, can play an important role in the prevention of PIE. In this regard, assessing the effect of stroke treatment in the most acute and acute stages on the risk of developing PIE is of interest to researchers in many countries [19].

A Norwegian study found that stroke increases the risk of developing epileptic seizures. Moderate to severe stroke was a statistically significant predictor of epilepsy in a Norwegian population. Researchers noted the importance of studying the risk and causes of PIE after stroke, as well as knowledge of therapy to prevent PIE for general practitioners and subspecialties [19]. A study conducted at the Norwegian National Epilepsy Center found that 484 patients with late-onset epilepsy had a history of stroke. Researchers have found that 2.5% of stroke patients develop PIE within one year after the stroke. In 3.1% of patients, post-stroke epilepsy developed within 7–8 years from the moment of stroke and/or cerebral infarction. In this case, the diagnosis of PIE was established in the study sample in the presence of two or more unprovoked epileptic seizures that developed within one week after the stroke or later. Analysis of associated potential risk factors that play a role in the development of PIE showed the significance of a score on the Scandinavian Stroke Scale of less than 30 points. These factors are most often detected in severe strokes and increase the risk of developing PIE [5].

Thus, stroke (hemorrhagic or ischemic) is a significant cause of the development of epilepsy in old age. This is very important, since PIE is one of the reasons for frequent visits to therapists [19].

M. Lossius et al. (2005) examined the prevalence of PIE, which was defined as 2 or more epileptic seizures that first developed no earlier than 4 weeks after the stroke. The study was based on a review of the available world literature covering the prevalence, risk factors, pathophysiology and prognosis of PIE. A large variability in the incidence of PIE development was shown - from 2.3 to 43% (according to different authors). Moreover, the average incidence of PIE was 2.5% during the first year after stroke, increasing to 4.4% over the next 5 years. Severe strokes were more predictive risk factors for the development of PIE than mild strokes. The authors explained the high variability in the frequency of PIE by the peculiarities of the course of stroke in different populations, different definitions of the diagnosis of PIE, and different designs of studies. On the other hand, severe strokes were characterized by high mortality, and patients with minor strokes, as a rule, did not have PIE. The authors showed that the risk of developing PIE doubles from the first to the fifth year after stroke [19].

Of great interest is a review of the literature on the possibility of developing epileptic seizures (both convulsive and non-convulsive) in patients who have suffered an ischemic stroke, published by O. Camilo, LB Goldstein (2004). The authors showed a very large variability in the incidence of PIE - from 2 to 33% in the early post-stroke period and from 3 to 67% in the late post-stroke period. However, the average incidence of PIE (according to data obtained through mathematical processing) was 2.4% and was higher in cases where epileptic seizures developed late after the stroke. The authors noted that to better understand the social aspects of PIE and its prevention and adequate treatment, many national studies are needed [7]. This can be explained by the peculiarity of long-term epileptogenesis in patients in the older age group.

On the other hand, the available medical literature, based on a study conducted in the UK, shows that patients with late onset epilepsy (after 60 years of age) have an increased risk of developing stroke. Based on an analysis of the National Center for General Practitioner Statistics database, R. Tallis et al. (Department of Geriatric Medicine at the University of Manchester) analyzed 4,709 clinical cases of PIE in England and Wales and 4,709 age-matched controls (over 60 years) without a history of epilepsy. This population-based study included individuals who had no history of cerebrovascular pathology, brain injury, brain tumors, alcohol or drug addiction, dementia, or no indication of taking antiepileptic drugs for any other reason. The average year of birth in this sample was 1920. Both groups (control and matched) included 2044 men and 2645 women. It was shown that stroke developed in 10% of patients with epilepsy compared to 4.4% of individuals in the control group. The absolute difference was 5.6%. The average risk of stroke in the matched group was 2.89%, compared with 1.4% in patients with high HDL cholesterol concentrations. The authors noted that patients who developed epileptic seizures in old age have an increased risk of stroke [12].

The first largest study to study the problem of PIE in Russia was carried out by E.S. Prokhorova (1982). The result showed that the incidence of PIE after hemorrhagic stroke (intracerebral hemorrhage) was 8.69% of cases, after ischemic stroke - 4.12% of cases. Interestingly, the frequency of epileptic seizures in PNMC was quite high and amounted to 8.8% of cases, which was comparable to the data of O. Daniele (1989) - 9% of cases [3, 10].

According to A.B. Hecht et al. (2003), in the Russian population the incidence of PIE is about 9.6%, while in 6% of patients epileptic seizures developed within the first week from the onset of stroke and were classified as early epileptic seizures. PIE later than the first week from the onset of stroke was registered in 5.4% of patients; in 60% of patients, PIE developed between the 3rd and 12th months of the recovery period. The average incidence of PIE was 4.2% of cases, which is comparable to the results of studies conducted in Norway and the UK. The cumulative risk of PIE by the end of the first year after stroke was 3.27%, and by the end of the second year of follow-up - 5.7%. The authors noted that the development of early epileptic seizures had a negative impact on the course of the recovery period of stroke, predisposing to continued severity of neurological deficits, low survival rates and the risk of developing a recurrent stroke within two years after the initial stroke. The most significant risk factors for the development of PIE were: old age (50–59 years), atrial fibrillation, stroke severity, as well as smoking and alcohol abuse. At the same time, the authors showed that PIE developed more often in strokes of moderate severity and minor strokes, with cerebral infarction foci measuring 10–30 mm, predominantly in the frontal and temporal localization (according to MRI data) [1, 2].

M. E. Lancman et al. (1993), analyzing MRI data in patients with PIE, showed the greatest risk of developing seizures after hemorrhagic strokes, cortical infarctions, as well as strokes with extensive brain damage (within more than one lobe) [17]. A significant risk factor for the development of PIE is the development of status epilepticus in the acute and acute periods of stroke [25].

Treatment of PIE is much more complex compared to the treatment of epilepsy in young patients [14, 23]. This is associated with an increased risk of drug-drug interactions, age-dependent hepatic and renal dysfunction, requiring increased intervals for taking antiepileptic drugs compared with young and middle-aged patients, cognitive impairment in the elderly associated with concomitant Alzheimer's disease, Parkinson's disease, hypertensive multi-infarct encephalopathy, exogenous toxic (alcoholic) encephalopathy, etc., which potentiate increased sensitivity and increased side effects of antiepileptic drugs [18]. Dose-related side effects of antiepileptic drugs, such as dizziness or balance disorders, as well as drug-specific side effects, such as hyponatremia or tremor, may be due to higher serum concentrations of antiepileptic drugs compared to younger patients [23]. The increase in side effects of anticonvulsants may be due to the elderly age of patients; for example, the risk of AED-associated osteoporosis and osteomalacia while taking phenobarbital, phenytoin, and permidon significantly increases [20]. At the same time, the risk of developing osteopenia and osteoporosis increases significantly with polytherapy compared to monotherapy. On the other hand, information on studies of new anticonvulsants in the elderly is limited [18]. Thus, in 2004 in the United States, 21,435 war veterans (patients with epilepsy over 65 years of age) were treated with phenobarbital and phenytoin in more than 80% of cases [21], although both of these drugs have a significant sedative effect and cause the development of cognitive impairment, as well as potentiate drug-drug interactions [26]. Phenytoin causes dosing difficulties in older patients because it has non-linear side effects.

Elderly patients receive many medications for both epilepsy and somatic diseases. Antiepileptic drugs may enter into drug-drug interactions with other drugs. A minimal drug-drug interaction profile has been described only for new antiepileptic drugs (gabapentin, levetiracetam) [27]. Both drugs are effective in focal epilepsy and are excreted primarily unchanged through the kidneys, but their dosage depends on the impairment of renal function. Somnolence may mimic the use of these drugs [18]. According to recent studies, only 25% of patients with late-onset epilepsy have generalized tonic-clonic seizures, 43% have only complex focal seizures, 32% have focal seizures, which are extremely difficult to diagnose in older age groups because they are underestimated by both patients and his relatives and neurologists.

Traditional antiepileptic drugs - carbamazepine, phenytoin, valproate are metabolized in the liver. Thus, carbamazepine and phenytoin, by inducing hepatic metabolism, can reduce the effects of many drugs, including chemotherapy, glucocorticosteroids or warfarin. Valproate and lamotrigine inhibit hepatic metabolism and increase the risk of developing liver failure, especially against the background of existing hepatoduodenal insufficiency. Carbamazepine significantly increases the risk of hyponatremia, which should be taken into account when treating patients with PIE receiving treatment for arterial hypertension using thiazide diuretics (hypothiazide, indapamide, arifon). At the same time, the frequency of dizziness, lethargy, and somnolence associated with hyponatremia increases significantly [24]. In this regard, it is important to conduct clinical pharmacomonitoring of the concentrations of carbamazepine (finlepsin, tegretol, etc.) and oxcarbazepine (trileptal), as well as the concentration of sodium in the blood serum.

Among the side effects of antiepileptic drugs in the older age group, the most common are: weight gain - 55.3%, sedation - 44.3%, gastrointestinal complications - 29.5%; memory and thinking disorders - 29.1%, dizziness - 28.7%, weight loss - 27.6%, cognitive impairment - 27.2%, hyponatremia - 7.1% [22]. AED-induced side effects in patients with post-stroke epilepsy can be minimized by stepwise dosage selection, starting with minimal doses followed by titration to an effective dose [23].

Among the diagnostic tests for post-stroke epilepsy, the most significant are: magnetic resonance imaging of the brain and magnetic resonance angiography (if indicated), electroencephalography with mandatory daytime, nighttime, and if possible, 24-hour EEG monitoring, laboratory studies of the electrolyte balance of the blood serum, a study of the concentration of anticonvulsants in the blood ( clinical pharmacomonitoring of antiepileptic drugs), examination of the cardiovascular system, including consultation with a cardiologist, ECG, echocardiography, Holter monitoring (if indicated), testing of cognitive functions.

How to get rid of post-stroke epilepsy seizures

Treating epileptic seizures is quite difficult, even in patients who have not had a stroke. A neurologist is required to understand the mechanisms of disease development.

Before prescribing a course of therapy, a thorough examination of the patient, neurological diagnostics, and an assessment of the body’s condition are carried out. When treating symptomatic epilepsy with pharmacological agents, it is necessary to take into account the interaction of the prescribed drugs with those that the victim is already taking.

Traditional therapy involves prescribing the following drugs:

Carbamazepine.
Valproic acid preparations.
Convulsofin.
Depakine.

Prescription of Depakine is especially effective in the treatment of elderly people. The drug does not cause cognitive impairment and does not depress respiratory function. Epilepsy attacks can be stopped with the help of new generation drugs - Lamotrigine, Tiagabine, etc.

Read also: Rehabilitation after a stroke in Moscow

How to live with post-stroke epilepsy

Epilepsy after a stroke can occur for various reasons, but the main factor in its development remains the patient’s advanced age.

The victim and his family will have to learn to distinguish between the conditions that precede the development of an attack, and also to determine for what reasons epilepsy attacks occur after a stroke. Regular consultation with a neurologist and adjustments to eating habits and lifestyle will be required.

It is also recommended to stop drinking alcohol and smoking. A healthy lifestyle and regular medications will help you adapt to the new condition and lead a relatively normal life.

Post-stroke epilepsy

ON THE. Schneider, A.V. Chatskaya, D.V. Dmitrenko, O.I. Shevchenko, Department of Medical Genetics and Clinical Neurophysiology of the Institute of Postgraduate Education of the State Educational Institution of Higher Professional Education "Krasnoyarsk State Medical Academy of the Federal Agency for Health and Social Development"; S.V. Prokopenko, Department of Nervous Diseases, Krasnoyarsk State Medical Academy of the Federal Agency for Health and Social Development, Russia

Summary

This review examines current epidemiological and clinical data on post-stroke epilepsy.

Keywords

post-stroke epilepsy, prevalence.

It is believed that 30–40% of cases of late-onset epilepsy in people over 60 years of age are associated with a stroke [6, 11, 19, 28].

AED-induced side effects in patients with post-stroke epilepsy can be minimized by stepwise dosage selection, starting with minimal doses followed by titration to an effective dose [23].

Literature 1. Burd G.S., Gekht A.B., Lebedeva A.V. et al. Epilepsy in patients with ischemic cerebral disease // Journal. neurol. and psychiatry. - 1998. - No. 2. - P. 4-8. 2. Gekht A.B., Lebedeva A.V., Poletaev A.B. et al. Post-stroke epilepsy // Stroke. - 2003. - No. 9. - P. 195. 3. Prokhorova E.S. Epileptic seizures in cerebrovascular accidents in patients with ischemic disease and atherosclerosis: Abstract of thesis. Dis... Dr. med. Sci. - M., 1981. - P. 42. 4. Arboix A., Garcia-Eroles L., Massons JB et al. Predictive factors of early seizures after acute cerebrovascular disease // Stroke. - 1997. - Vol. 28, No. 8. - R. 1590-1594. 5. Barolin GS, Sherzer E. Epileptische Anfalle bei Apoplektikern // Wein Nervenh. - 1962. - Vol. 20. - P. 35-47. 6. Berges S., Moulin T., Berger E. et al. Seizures and epilepsy following strokes: recurrence factors // Eur. Neurol. - 2000. - Vol. 43, No. 1. - R. 3-8. 7. Camilo O., Golgstein LB Seizures and epilepsy after ischemic stroke // Stroke. - 2004. - Vol. 35, No. 7. - P. 1769-1775. 8. Cheung CM, Tsoi TH, Au-Yeung M, Tang AS. Epileptic seizures after stroke in Chinese patients // J. Neurol. - 2003. - Vol. 250, No. 7. - R. 839-843. 9. Cleary P., Shorvon S., Tallis R. Late-onset seizures as a predictor of subsequent stroke // Lancet. - 2004. - Vol. 363. - P. 1184-1186. 10. Daniele O., Mattaliano A., Tassianari CF, Natale E. Epileptic seizures and cerebrovascular disease // Acta Neurol. Scand. - 1989. - Vol. 80. - P. 17-22. 11. Hauser WA, Ramirez-Lassepas M., Rosenstein R. Risk for seizures and epilepsy following cerebrovascular insults // Epilepsia. - 1984. - Vol. 25. - P. 666. 12. Hendry J. Seizure onset after age 60 years associated with increased risk of stroke // Lancet. - 2004. - Vol. 363. - R. 1184-1186. 13. Kellinghaus C., Loddenkemper T., Dinner DS et al. Seizure semiology in the elderly: a video analysis // Epilepsia. - 2004. - Vol. 45. - P. 263-267. 14. Kilpatrick CJ, Davis SM, Tress BM et al. Epileptic seizures in acute stroke // Arch. Neurol. - 1991. - Vol. 48, No. 1. - P. 9-18. 15. Kilpatrick CJ, Davis SM, Tress BM et al. Epieptic seizures in acute stroke // Arch. Neurol. - 1990. - Vol. 47, No. 2. - R. 157-160. 16. Lamy C., Domigo V., Semah F. et al. Early and late seizures after cryptogenic ischemic stroke in young adults // Neurology. - 2003. - Vol. 60, No. 3. - R. 365-366. 17. Lancman ME, Golimstoc A., Norscini J., Granillo R. Risk factors for developing seizures after a stroke // Epilepsia. - 1993. - Vol. 34, No. 1. - R. 141-143. 18. LaRoche SM, Helmers SL Epilepsy in the elderly // Neurologist. - 2003. - Vol. 9. - P. 241-249. 19. Lossius MI, Ronning OM, Slapo GD et al. Poststroke epilepsy: occurrence and predictors-a long-term prospective controlled study Akershus Stroke Study // Epilepssia. - 2005. - Vol. 46, No. 8. - R. 1246-1251. 20. Pack AM, Morrell MJ Epilepsy and bone health in adults // Epilepsy Behav. - 2004. - Vol. 5. - P. 24-29. 21. Pugh MJV, Cramer J, Knoefel J et al. Potentially inappropriate antiepileptic drugs for elderly patients with epilepsy // J. Am. Geriatr. Soc. - 2004. - Vol. 52. - P. 417-422. 22. Ramsay RE, Rowan AJ, Pryor FM Treatment of seizures in the elderly: final analysis from DVA cooperative study # 428 // Epilepsia. - 2003. - Vol. 44, No. I9. - R. 170. 23. Ramsay RE, Rowan AJ, Pryor FM Special considerations in treating the elderly patient with epilepsy // Neurology. - 2004. - Vol. 62. - P. 24-29. 24. Ranta A., Wooten GF Hyponatremia due to an additive effect of carbamazepine and thiazide diuretics // Epilepsia. - 2004. - Vol. 45. - R. 879. 25. Rumbach L., Sablot D., Berger E. et al. Status Epilepticus in stroke: report on a hospital-based stroke cohort // Neurology. - 2000. - Vol. 54, No. 2. - R. 350-354. 26. Shorvon SD Handbook of epilepsy treatment. - Oxford (United Kingdom): Blackwell Science, 2000. 27. Sirven JI The current treatment of epilepsy: a challenge of choices // Curr. Neurol. Neurosci. Rep. - 2003. - Vol. 3. - R. 349-356. 28. So EL, Annegers JF, Hauser WA et al. Population-based study of seizure disorders after cerebral infarction // Neurogy. - 1996. - Vol. 46, No. 2. - R. 350-355. 29. Zaidi A., Clough P., Cooper P. et al. Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause // J. Am. Cool. Cardiol. - 2000. - Vol. 36, No. 1. - P. 181-184.

Prognosis for epilepsy after a stroke: what to watch out for

When brain tissue is damaged, unpredictable consequences are possible: paralysis, seizures, coma. If epilepsy occurs after a stroke, the prognosis will depend on the speed of response of medical personnel and the subsequent condition of the patient in the first days. The chronic form of the disease develops in people only in 4-5% of cases. But there are acute situations when epilepsy lasts for several days or weeks.

Epilepsy after stroke forecasts

There are often cases when, after suffering an ischemic or hemorrhagic stroke, a person begins to have epileptic seizures. They can appear for several reasons.

Seizures are a consequence of acute vascular insufficiency. Statistics say that chronic epilepsy after a cerebral hemorrhage develops in 4-5%. This article will focus specifically on these attacks.

Causes

Epilepsy is a disease that occurs due to metabolic disorders in the brain. As a result, the nervous tissue becomes hyperexcitable: a strong discharge easily occurs in it, leading to an attack.

Reference! Scientists consider epilepsy to be a hereditary disease. The likelihood of getting sick increases if there are relatives in the family with a similar problem.

The following factors also increase the chance of developing seizures:

head injuries;
complications during childbirth;
hormonal imbalance;
frequent stress;
non-compliance with the work and rest regime.

Often the disease is not independent.

It can serve as a symptom of other ailments.

These include meningitis, vascular pathologies, and poisoning with various substances.

It is customary to distinguish three main groups of attacks:

Harbingers. They can occur months or even years immediately before the stroke itself. Their appearance is associated primarily with chronic vascular pathology.
Early. Occurs in the first week after a stroke. According to statistics, such attacks account for 25% of all seizures.
Late. They are fixed at least a week after an acute imbalance of normal blood flow. Sometimes the rate of post-stroke seizures reaches 70%. They can happen one or several times.

Frequency of development of epileptic seizures

How does the disease manifest itself?

All types of attacks are characterized by suddenness.

A few days before the attack, the patient may begin to complain of lack of sleep, headache, poor appetite, and constant fatigue.

Usually the attack goes like this:

a man screams and falls sharply;
he begins to have convulsions;
Random urination is often observed;
the patient’s breathing is disrupted, most of it becomes intermittent, and the pressure in the chest increases;
if the case is classified as special, the tongue sinks in and liquid foam pours out of the mouth.

perform artificial respiration;
heart massage;
hold limbs;
open the patient's mouth;
delay in calling doctors.

Unprofessional help can only harm the victim.

How dangerous is this?

If secondary epilepsy is detected, then some complications are possible, since the body is already weakened.

The first seven days after an ischemic stroke occur are considered the most difficult in medical practice.

Consequences of early epilepsy:

loss of consciousness;
a person may fall into a prolonged coma;
breathing problems, as a person often accidentally swallows his tongue;
pathologies of internal organs.

Important! Seizures after a stroke do not always indicate epilepsy. In this regard, diagnosis is necessary.

Types of seizures after a stroke

Doctors distinguish 3 forms of post-stroke epilepsy:

Harbingers . Usually begin several months or years before the onset of a stroke. They are mainly associated with the ischemic form of the disease, which is characterized by oxygen starvation and impaired blood circulation in certain areas of the brain for a long time. In some patients, a mini-stroke is predicted several days or weeks in advance.

Early attacks . They develop within 6-7 days after the onset of an ischemic attack. Seizures are acute in nature and can appear either together with a stroke or immediately after it. If help is provided in time, the prognosis is favorable.
Late attacks . They develop 7-8 days after a stroke. Occurs in 65-70% of patients, so you need to be prepared for a similar condition within the specified time after acute ischemia. The prognosis worsens if first aid is provided too late.

Epilepsy can be called only those seizures after a stroke that persist for some time.

What is post-stroke epilepsy?

Let's look at each type separately and why they arise.

Premonitory seizures . In most cases, they occur due to prolonged vascular insufficiency. Sometimes this type of seizure is the only warning sign of an ischemic attack or stroke. This type of stroke is not capable of causing pronounced neurological signs. Such seizures should pay special attention, especially to patients with ischemic brain disease. They are also able to indicate where the focus of ischemia is located.
Early attacks of post-stroke epilepsy . In most cases, patients experience them in the first days after suffering a disorder. They are considered to be symptomatic attacks. The development of these types of seizures is provoked by a cytotoxic metabolic change in the ischemic focus. Early attacks stop as soon as metabolic processes in the lesion return to normal.
Late attacks . They also occur in the first days after the disorder. They have the appearance of unprovoked seizures, which are associated with pathology and the condition after a stroke.

Experts associate various attacks of epilepsy during the recovery period with cortical atrophy or with a post-ischemic cyst in the brain. This cyst can have a small size and is located in the cortex; as a rule, an epileptic focus then forms there.

Causes of post-stroke seizures

The prognosis, complexity of treatment and the patient’s condition depend on what causes epilepsy after a stroke. There are several groups of reasons. The first is general, not directly related to ischemia: long-term withdrawal of alcohol in those suffering from alcoholism, sudden changes in sugar levels, withdrawal of anticonvulsants, changes in sodium in the blood.

The causes are also neuralgic disorders that affect the prognosis in the long term: initial changes in the brain, arteriovenous malformation, thrombosis, cytopathy or hypertensive encephalopathy.

When medical errors worsen the prognosis, an incorrect diagnosis is often found: a brain tumor or abscess, encephalitis that developed against the background of herpes simplex, or subdural empyema.

Factors that provoke attacks

In recent years, the number of patients who develop epilepsy after a stroke has increased significantly. WHO names old age as the main factor provoking its development. Due to changes in regeneration functions and general aging, the body can no longer cope normally with injuries received, including changes in the structure of the brain.

In the post-stroke state, epilepsy occurs in 3 stages:

onset - due to disturbances in the damaged area, general blood circulation in the brain worsens;
due to chronic oxygen starvation, coronary disease appears, causing mild convulsions;
after an acute attack of ischemia, an epileptic seizure develops immediately or after a short period of time, depending on changed metabolic processes.

Course of attacks after circulatory disorders

The first signs of epilepsy develop within a few days after suffering a stroke. In some cases they occur after the first week. Seizures occur unexpectedly and cannot be recognized in advance.

In approximately 90% of cases, the condition occurs against the background of damage to cortical structures and due to the formation of cystic formations. Due to scarring of damaged tissue, some patients experience late attacks that occur several months after the stroke.

According to the sensations, patients note the following conditions when an epileptic attack approaches after a stroke:

the psycho-emotional state changes: insomnia develops, appetite disappears, severe weakness occurs, from which you don’t want to get out of bed, and headaches often occur;
the aura period is a state in which a person feels something incomprehensible, his perception changes. The aura is different for each person, and it is impossible to name common symptoms;
loss of consciousness - not all attacks can be recognized before a seizure; before loss of consciousness, convulsions always begin, pressure in the chest increases, breathing changes, in severe cases, the tongue sinks and foam appears at the mouth.

Epilepsy is possible after a stroke

On the Komsomolskaya Pravda direct line about stroke, Lyudmila Anatskaya, a neurologist, candidate of medical sciences, leading researcher at the Republican Scientific and Practical Center for Neurology, answered several dozen questions from readers.

The beginning of the direct line in Komsomolskaya Pravda for November 3 and here

“I had a stroke and now I’m losing consciousness”

— From Minsk, 63 years old, my cheek periodically goes numb and I get headaches. Tell me, should medications to improve cerebral circulation be taken continuously or in courses, and what is the frequency?

— Before you start taking vasoregulatory drugs, it is necessary to undergo ultrasound diagnostics of the main arteries of the head. And depending on whether there is a slowdown in blood flow or, conversely, vasospasm, drugs are selected. In addition, these drugs are not taken constantly - only in courses of 1 - 2 months every six months.

— My husband suffered two heart attacks, underwent bypass surgery, had a stroke on March 30, now he walks a little, but one arm does not work. And recently I had a seizure disorder.

— The cause of the convulsive syndrome could be a repetition of the embolism - when a blood clot from the heart enters the arteries supplying blood to the cerebral cortex: this can cause an epileptic attack, or the focus of a cerebral infarction itself can become the zone for the formation of an epileptic attack. You need to contact your neurologist or cardiologist and replace your drug, if he recommends it, with a stronger one, if there are no contraindications - an anticoagulant that prevents the formation of cardiac emboli.

- Victoria Ivanovna is worried. Two years ago I had a stroke. And somehow it’s getting worse every day. There were no heart problems, no diabetes. I lost consciousness several times.

— Loss of consciousness like fainting? 75% of fainting occurs due to cardiac problems. You need to do an ultrasound of the heart and Holter monitoring of the heart rhythm. Secondly, you need to do an electroencephalogram of the brain to exclude the possibility of epileptic seizures - after a stroke, post-stroke epilepsy can develop. If this is her, you should take epilepsy medications. If fainting is related to the heart, you should take medications that will prevent fainting. So you need to undergo three examinations, and with the results go to a cardiologist and a neurologist. Attacks of loss of consciousness are quite serious.

Loneliness and walks - doctors!

— I’m 84 years old, I had a mini-stroke in ’98, then in 2008 I had a cerebral infarction, I lost speech, then recovered. I take all medications to prevent heart disease, medications that thin the blood, lower blood pressure, and lower cholesterol. I live alone, I sit at home, I only go to the store.

— Today you have a balanced regimen for the prevention of recurrent stroke. But for people who have had a stroke, a daily 30-minute exercise is recommended, a short half-hour walk so that you don't sweat or feel your heartbeat. By the way, doctors have noticed that people who live alone recover from a stroke much better. They have an incentive to rehabilitate because they have to do everything on their own.

— I’m from Zaslavl, very young, I’m 72 years old, I had a stroke in ’94. Tell me, will I still be able to restore my health? There was still weakness in the hand and numbness. I do exercises, work at the dacha for several hours, and walk five kilometers a day.

“Your task is to prevent another stroke from occurring.” It is not worth working out a lot physically: physical activity can provoke a second stroke. 30 minutes a day is better - slowly. And you can do exercises, but moderately so that your heart rate doesn’t increase and you don’t sweat. Five kilometers for a walk for a person who has suffered a stroke is a lot; three kilometers a day is enough for you. Don't overexert yourself, otherwise it may get worse. And numbness is the worst to recover and, as a rule, nothing can be fixed.

- This stroke happened when I opened a tightly screwed tap - right in the bathroom.

— One of the most serious factors provoking a stroke is physical overexertion. It can cause a blood clot to break off.

STAY IN TOUCH!

Symptoms of a stroke:

- Sudden numbness or weakness in the face, arm or leg, especially on one side of the body.

- Sudden speech impairment - difficulty understanding words and their pronunciation.

- Visual impairment, sudden double vision.

- Sudden loss of coordination, gait, dizziness.

- Sudden sharp headache for no reason.

- Sudden loss of consciousness.

- Sudden psychomotor agitation.

If you have any of these signs, do not hesitate to call an ambulance. Don’t hope that it will “dissolve on its own.” In most cases, timely treatment allows, if not completely avoiding the consequences, then at least not becoming disabled. And it’s worth remembering: strokes don’t only happen to older people—they happen even to young people.

Danger of seizures

A stroke dramatically weakens one’s health, and post-stroke epilepsy only undermines one’s overall well-being. If in a person who does not suffer from other pathologies, the disease does not lead to extremely severe consequences, then in a person who has suffered a hemorrhage, the risk is high: the person falls into a coma, dysfunction of various organs occurs, blood circulation worsens, and vascular health worsens.

The process of post-stroke epilepsy itself is also dangerous, during which the patient can suffer head injuries. Some experience respiratory arrest, against which secondary hypoxia develops.

Due to post-stroke epilepsy, a person has an increased risk of having a recurrent stroke. If it happens, the chances of survival are reduced several times. With frequent convulsions that do not go away after attempts at treatment, doctors assume the presence of internal bleeding, which ultimately causes death.

Timely assistance increases the chance of recovery and affects the favorable prognosis. But, if medical participation does not occur, then with a 90% probability the person dies or becomes disabled.

All about epileptic seizures during stroke

The high incidence of stroke entails a high prevalence of post-stroke epileptic seizures, which can occur in people with or without epilepsy.

Epileptic seizures provoked by acute vascular insufficiency can be a consequence of systemic disorders in the body or direct damage to the brain. 4–5% of people develop chronic epilepsy after a stroke.

Vascular insufficiency may cause seizures after stroke

There are 3 groups of seizures:

Precursor seizures occur months or even years before a stroke. Their appearance is associated with chronic vascular insufficiency and may be the only symptom of a transient ischemic attack (ministroke), a “silent” stroke.
Early, occurring in the first week of the disease. They account for up to 25% of all post-ischemic attacks. Among the early ones, it is necessary to distinguish the most acute seizures that occur simultaneously with the onset of a stroke or immediately after it. Some doctors include all seizures that occurred before the disappearance of acute signs of cerebral ischemia as early attacks.
Late, starting 7 days or later after an acute cerebral circulatory disorder. They account for 65–70% of post-stroke seizures. Seizures can be single or recurrent, and only late recurrent seizures should be called post-stroke epilepsy.

How often does the disease occur?

The risk of developing seizures after a stroke varies greatly depending on the person's age: it develops in 2% of children under 2 years of age and in 5% of children 8 years of age, with a second peak occurring between the ages of 17 and 23 years, but the highest incidence is observed among patients older than 60 years – 20–30%.

In 2.5% of patients they develop during the first year after a stroke and in 5% in the next 5 years. Elderly men are more susceptible to the disease, since they have more risk factors - smoking, atherosclerosis, high blood fat levels.

Post-stroke epilepsy develops in 3–5% of people after a moderate stroke and in 20% after a severe form.

https://www.youtube.com/watch?v=bdSvWkb_3jI

With hemorrhagic stroke, the disease develops 2 times more often than with ischemic stroke.

Causes

The reasons are not fully understood, but it can be confidently stated that various disorders of the blood supply to the brain play a leading role in the development of the disease - atherosclerosis, blood clots, abnormalities in the development of cerebral vessels, ischemia. An important role is played by brain damage when blood sugar levels change as a result of side effects of medications.

Development mechanism

Biochemically, the development of epilepsy is associated with disruption of ionic and energy processes and nerve impulse transmission. These disorders lead to extremely high excitability of nerve cells, and then to seizures.

Epileptic seizures are caused by disturbances in the transmission of nerve impulses

Early attacks are caused by metabolic disorders in the area of ischemia, as well as the negative impact of ischemia on healthy brain structures - a sudden impulse and high discharges of nerve cells appear.

Early attacks stop immediately after the restoration of metabolic processes in the lesion.

The development of late attacks is associated with the formation of cysts after a stroke and the replacement of nervous tissue in the cortex or white matter of the brain.

The location of the infarction plays a leading role in the occurrence of an attack - attacks occur when the cerebral cortex is damaged and practically do not occur when the subcortex, cerebellum, thalamic region, or deep layers of the brain are damaged.

Treatment

Treatment of post-stroke seizures is much more difficult than treatment of epilepsy in young people.

This is due to the age of the patients - the condition of older people is aggravated by age-related changes in the body (liver and kidney failure), and mental impairment.

Older people take a sufficient amount of medications to treat comorbidities, which subsequently poses the risk of drug interactions. In people over 50 years of age, taking antiepileptic drugs increases the risk of developing osteoporosis.

Treatment principles:

It is necessary to avoid prescribing medications that provoke seizures. A classic example is Eufillin, but theoretically most vascular and metabolic drugs can provoke an attack, but practice shows that their administration does not play a big role in the treatment of acute cerebral circulatory disorders and does not affect its consequences. But Magnesium sulfate and Diacarb are not able to provoke epilepsy and even have a slight antiepileptic effect.
It is necessary to treat stroke and somatic diseases, since the occurrence of epileptic seizures is associated with cerebral edema, displacement of brain structures, increased and decreased blood sugar, decreased potassium levels and intoxication as a result of renal failure.
It is necessary to carry out anticonvulsant treatment. If the patient is conscious, he is prescribed tablets; if, due to the severity of the condition, the swallowing reflex is impaired, injections have to be given or medications administered through a tube, Depakin, Konvulex, Levetiracetam, Propofol are used. The listed drugs relieve the symptoms of an attack, but do not treat epilepsy or reduce the risk of its occurrence.

Comprehensive drug treatment will help relieve the patient from epileptic seizures

The listed drugs are prescribed strictly justifiably, since they have a number of side effects that aggravate the severity of cerebral ischemia. They need to be prescribed:

patients with active seizures;
patients in a coma whose electroencephalogram shows signs of epilepsy (increased convulsive activity);
stroke patients who had early attacks;
Patients with a severe, extensive form of stroke require prophylactic administration of antiepileptic drugs in a situation where the possible occurrence of an attack threatens deterioration of health or death.

The threat to a sick person is not muscle cramps, but the resulting huge electrical discharges in the cerebral cortex. Therefore, treatment should continue not until the seizures are eliminated, but until normal electroencephalogram readings are restored.

Seizures caused by a stroke are relatively treatable.

Post-stroke epileptic seizures significantly worsen the clinical picture of stroke; negative consequences include a decrease in the quality of life of patients in the acute and recovery periods of the disease. And the most undesirable consequence is that epilepsy provokes new attacks of acute cerebrovascular accident.

Source: https://GolovaLab.ru/insulto/simptomy/epilepticheskiy-pripadok-pri-insulte.html

First aid for seizures

If the attack began far from a medical facility, relatives and friends can help a patient with epilepsy:

you must immediately call an ambulance;
if a person faints, he must be laid down at the place of the fall and freed from tight clothing;
fresh air is needed - open the windows;
the head is raised higher than the legs, it is necessary to ensure that there are no open injuries that occur as a result of a fall;

then you need to check if there is any food left in your mouth; if any food is found, you need to take it out;
if a person has removable dentures installed, the ears are removed from the oral cavity;
if convulsions with wheezing occur, the body should be turned on its side and ensure that breathing does not stop;
if the seizure lasts longer than a few minutes, you need to gently hold the patient so that he does not hit himself or receive other injuries, but it is impossible to prevent seizures by holding his arms and legs;
If a person is conscious, but severe muscle spasms occur, they can be rubbed using the recommended products (for example, olive oil).

After the ambulance team arrives, you need to describe the patient’s well-being and say what medications he took. The more accurate the descriptions are, the greater the chances of a favorable treatment prognosis.

Epilepsy after stroke: prognosis and complications

The chronic form of the disease develops in people only in 4-5% of cases. But there are acute situations when epilepsy lasts for several days or weeks.

Types of seizures after a stroke

Doctors distinguish 3 forms of post-stroke epilepsy:

Harbingers . Usually begin several months or years before the onset of a stroke. They are mainly associated with the ischemic form of the disease, which is characterized by oxygen starvation and impaired blood circulation in certain areas of the brain for a long time. In some patients, a mini-stroke is predicted several days or weeks in advance.

Early attacks . They develop within 6-7 days after the onset of an ischemic attack. Seizures are acute in nature and can appear either together with a stroke or immediately after it. If help is provided in time, the prognosis is favorable.
Late attacks . They develop 7-8 days after a stroke. Occurs in 65-70% of patients, so you need to be prepared for a similar condition within the specified time after acute ischemia. The prognosis worsens if first aid is provided too late.

Epilepsy can be called only those seizures after a stroke that persist for some time.

Causes of post-stroke seizures

Post-stroke epilepsy appears as a result of the use of drugs to treat ischemia: muscle relaxants, antibiotics, antidepressants, antiarrhythmic drugs, phenothiazines.

The causes are also neuralgic disorders that affect the prognosis in the long term: initial changes in the brain, arteriovenous malformation, thrombosis, cytopathy or hypertensive encephalopathy.

When medical errors worsen the prognosis, an incorrect diagnosis is often found: a brain tumor or abscess, encephalitis that developed against the background of herpes simplex, or subdural empyema.

Factors that provoke attacks

In the post-stroke state, epilepsy occurs in 3 stages:

onset - due to disturbances in the damaged area, general blood circulation in the brain worsens;
due to chronic oxygen starvation, coronary disease appears, causing mild convulsions;
after an acute attack of ischemia, an epileptic seizure develops immediately or after a short period of time, depending on changed metabolic processes.

However, post-stroke epilepsy does not always develop solely against the background of ischemic damage. With hemorrhagic hemorrhage, which involves more than 1 lobe of the brain, a convulsive state is also possible.

Course of attacks after circulatory disorders

The first signs of epilepsy develop within a few days after suffering a stroke. In some cases they occur after the first week. Seizures occur unexpectedly and cannot be recognized in advance.

According to the sensations, patients note the following conditions when an epileptic attack approaches after a stroke:

the psycho-emotional state changes: insomnia develops, appetite disappears, severe weakness occurs, from which you don’t want to get out of bed, and headaches often occur;
the aura period is a state in which a person feels something incomprehensible, his perception changes. The aura is different for each person, and it is impossible to name common symptoms;
loss of consciousness - not all attacks can be recognized before a seizure; before loss of consciousness, convulsions always begin, pressure in the chest increases, breathing changes, in severe cases, the tongue sinks and foam appears at the mouth.

Danger of seizures

The process of post-stroke epilepsy itself is also dangerous, during which the patient can suffer head injuries. Some experience respiratory arrest, against which secondary hypoxia develops.

In severe cases, epilepsy can cause disability - constant seizures lead to irreversible changes in the brain.

Due to post-stroke epilepsy, a person has an increased risk of having a recurrent stroke.

If it happens, the chances of survival are reduced several times. With frequent convulsions that do not go away after attempts at treatment, doctors assume the presence of internal bleeding, which ultimately causes death.

Timely assistance increases the chance of recovery and affects the favorable prognosis. But, if medical participation does not occur, then with a 90% probability the person dies or becomes disabled.

First aid for seizures

If the attack began far from a medical facility, relatives and friends can help a patient with epilepsy:

you must immediately call an ambulance;
if a person faints, he must be laid down at the place of the fall and freed from tight clothing;
fresh air is needed - open the windows;
the head is raised higher than the legs, it is necessary to ensure that there are no open injuries that occur as a result of a fall;

then you need to check if there is any food left in your mouth; if any food is found, you need to take it out;
if a person has removable dentures installed, the ears are removed from the oral cavity;
if convulsions with wheezing occur, the body should be turned on its side and ensure that breathing does not stop;
if the seizure lasts longer than a few minutes, you need to gently hold the patient so that he does not hit himself or receive other injuries, but it is impossible to prevent seizures by holding his arms and legs;
If a person is conscious, but severe muscle spasms occur, they can be rubbed using the recommended products (for example, olive oil).

Treatment methods

Therapy for post-stroke epilepsy is based on the use of several drugs. The goal of treatment is to prevent recurrent attacks and avoid progression of the disease with subsequent complications. An individual anticonvulsant therapy program is selected for each patient (there are more than 20 drugs used for monotherapy).

The most popular drugs to combat epilepsy contain valproic acid.

In addition to anticonvulsants, antithrombosis agents, medications to improve blood circulation, and nootropics are prescribed. During treatment, the patient must adhere to certain rules:

do not violate the doctor’s instructions, otherwise the prognosis will change for the worse;
take medications strictly on schedule, after meals and at the same time;
if therapy is completed, the drugs are discontinued gradually;
if there is no improvement within 7-10 days, you need to consult a doctor to change the treatment regimen.

Most anticonvulsants require a doctor's prescription; using them on your own for personal preference is prohibited, even if the doctor gives a good prognosis for recovery.

When post-stroke epilepsy becomes chronic, the patient must change their lifestyle. It is necessary to take medications regularly, get enough sleep and eat right. Quitting alcohol and smoking is a prerequisite for good prognoses in the future. In most cases, attacks noticed in time after a stroke can be corrected. The patient lives for many years with acquired epilepsy without disability status (if it is not assigned as a result of the stroke itself).

Source: https://nevrology.net/sindromy-i-zabolevaniya/epilepsiya/prognozy-posle-insulta.html

Treatment methods

Therapy for post-stroke epilepsy is based on the use of several drugs. The main goal of treatment is to prevent recurrent attacks and avoid progression of the disease with subsequent complications. An individual anticonvulsant therapy program is selected for each patient (there are more than 20 drugs used for monotherapy).

In addition to anticonvulsants, antithrombosis agents, medications to improve blood circulation, and nootropics are prescribed. During treatment, the patient must adhere to certain rules:

do not violate the doctor’s instructions, otherwise the prognosis will change for the worse;
take medications strictly on schedule, after meals and at the same time;
if therapy is completed, the drugs are discontinued gradually;
if there is no improvement within 7-10 days, you need to consult a doctor to change the treatment regimen.

Most anticonvulsants require a doctor's prescription; using them on your own for personal preference is prohibited, even if the doctor gives a good prognosis for recovery.

Causes and features of clinical manifestations

Epilepsy is one of the manifestations of neurological disorders that occur in patients after a stroke. In particular, the formation of a post-stroke cyst leads to this complication.

The fact is that during a stroke, a part of a person’s brain cells dies, in place of which a cavity is formed, filled with intercellular fluid. The pressure of this formation on nearby tissues leads to most of the adverse consequences that occur after a stroke, including the development of epilepsy.

Features of the clinic

In most cases, epilepsy begins to manifest itself seven to ten days after the stroke.

A characteristic feature of post-stroke epileptic seizures is the absence of any visible provoking factors, as well as a sudden onset.

The clinical picture of epilepsy seizures after a stroke is as follows:

A few days before the onset of the attack, the patient experiences obvious psycho-emotional disorders, which can manifest themselves in the form of insomnia, headaches, lack of appetite, increased fatigue and general weakening of the body.
Epileptic seizures that occur after a stroke are characterized by the almost complete absence of the so-called aura - a set of specific symptoms preceding a seizure, which significantly complicates diagnosis.
The attack itself is characterized by such manifestations as convulsive syndrome, intermittent, hoarse breathing, foaming at the mouth, a feeling of increased pressure in the chest, possible retraction of the tongue and loss of consciousness.

What are the dangers of post-stroke epilepsy attacks?

Epileptic disease, which manifests itself after a stroke, has an extremely adverse effect on the weakened body of the patient. In addition, this neurological disease can cause the following complications:

Coma.
Dysfunction of internal organs.
Disruption of circulatory processes.
Worsening of vascular pathologies.

The seizures themselves pose a serious danger, during which serious injuries can occur (if the patient falls), respiratory arrest occurs as a result of blocking the airways with a sunken tongue, etc.

If the patient is not provided with competent assistance during an attack, the consequences can be the most unpredictable and severe, even death.

Therefore, when the first signs of epilepsy appear, you should definitely seek medical advice from a qualified specialist who, having carried out the necessary diagnostics, will be able to prescribe the patient a treatment that is quite effective for him.

Epilepsy after stroke causes, symptoms, treatment and prevention methods

Post-stroke epilepsy is a neurological pathology that occurs against the background of an ischemic or hemorrhagic stroke and is accompanied by convulsive seizures.

Occurs in every tenth patient after an attack of acute circulatory disorders in the brain. It can be idiopathic (arising for unknown reasons) and secondary (arising as a result of neurological disorders in the body).

To cure seizures, you need to see a neurologist.

What does epilepsy after a stroke mean?

The occurrence of epileptic seizures indicates instability of the nervous system and the presence of neurological abnormalities. Characteristic symptoms of the pathology:

slight dizziness, feeling of discomfort;
visual and auditory hallucinations;
partial loss of consciousness;
memory losses;
nervous disorders;
seizures with loss of consciousness;
uncontrolled movements;
muscle weakness of the body;
spasms and convulsions.

What diseases can epilepsy during a stroke be confused with?

Epileptic seizures are often confused with bipolar disorder due to similar symptoms:

frequent mood swings, sudden change from joy to aggression;
symptoms of depression (dejection, indifference, fatigue, decreased concentration);
it is almost impossible to establish the main and single cause of the disease;
manifests itself in children, adolescents, adults and the elderly equally.

How to relieve symptoms?

If a patient begins to have a seizure, several actions need to be taken:

Lay the person horizontally, unbutton their clothes so that they can breathe freely.
If severe cramps occur, roll the person onto their side.
There is no need to tie up the patient, perform cardiac massage or perform artificial respiration!
Keep the patient's head elevated.
Do not put any objects into your mouth to avoid damaging your jaw.

A neurologist treats epileptics. There is also an epileptologist, but there is no official position in Russia yet. The specialist consults and diagnoses the patient, selects and prescribes a course of treatment. The sooner you see a doctor, the greater the chances of a full recovery.

To cure the disease, you must first undergo diagnostics in a specialized clinic. Doctors prescribe the following studies:

neuropsychological studies;
Doppler ultrasound of the brachiocephalic arteries;
CT and MRI of blood vessels and soft tissues of the brain;
electroencephalography;
electrocardiography;
general blood and urine tests;
blood biochemistry;
cerebrospinal fluid puncture.

Drug treatment

During drug therapy, most doctors prescribe antiepileptic drugs of various groups. Medicines are aimed at inhibiting seizures, calming nerve fibers, preventing the transmission of electrical impulses, and restoring cerebral circulation. What drugs are most often prescribed:

carbamazepine;
lamotrigine;
phenobarbital;
ethosuximide;
diphenin;
levetiracetam;
topiramate;
hexamidine;
anticholinergics;
valproic acid.

The drugs can be prescribed in the form of tablets, capsules or injections.

Surgery

Surgery is used only in severe cases; surgical removal of the epileptogenic area of the brain is usually used. The procedure is performed endoscopically under a microscope. Such operations as lobectomy, hemispherectomy, hippocampectomy, and callosotomy are in demand abroad.

Conservative therapy

Physiotherapeutic procedures are used to treat epilepsy and quickly recover after a stroke:

oxygen therapy;
ozone therapy;
pine baths;
electrophoresis;
UV irradiation.

Therapeutic exercises, relaxing massage, swimming, as well as diet and daily routine are considered effective.

Sources

“The effectiveness of treatment of focal epilepsy in patients who have suffered a stroke”, YuA Belova, IG Rudakova, AS Kotov, Sergey Vladimirovich Kotov. Clinical gerontology 20 (7-8), 6-8, 2014.
“Some risk factors for the development of post-stroke epilepsy,” EK Muromtseva. Postgraduate Bulletin of the Volga Region, 48-52, 2013.
“Post-stroke epilepsy: predictors, risk factors, clinical options, treatment”, Tatyana Valerievna Danilova, DR Khasanova, IR Kamalov. Neurology, neuropsychiatry, psychosomatics, 2012.

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I found out about you on the Internet - I urgently need an MRI.

And after the performance I’m with you. I really liked your staff. Thank you for your attention, kindness and accuracy.

May everything be as good in your soul as I am now, despite all the problems...

Be!!! We're happy! Your Panina V.V.

[~PREVIEW_TEXT] =>

I found out about you on the Internet - I urgently need an MRI.

And after the performance I’m with you. I really liked your staff. Thank you for your attention, kindness and accuracy.

May everything be as good in your soul as I am now, despite all the problems...

Be!!! We're happy! Your Panina V.V.

Source: https://cmrt.ru/zabolevaniya/golovnogo-mozga/epilepsiya-posle-insulta/

Diagnostic methods and methods of therapy

Epilepsy after a stroke is diagnosed based on the results of the collected anamnesis, characteristic manifestations and general clinical picture. In addition, the patient may be prescribed the following types of studies:

Magnetic resonance imaging of the brain.
Electroencephalography.
Electrocardiogram.
Echocardiography.
Echoencephaloscopy.
Fundus examination.
Computed tomography of the brain.
Conducting a neurological test of cognitive functions.