Single seizure and epilepsy in patients with a cerebral territorial infarct

Background: The risk factors to develop stroke-related seizures are actually better understood. However, it is not known which patients are at risk to develop recurrent seizures and epilepsy. Objectives: This retrospective study compares the characteristics of patients with a territorial infarct who develop a single seizure to those who develop epilepsy. Patients and methods: The demographic and clinical features, the seizure type and onset time, the infarct location and the electroencephalographic (EEG) findings of 106 stroke patients with a single seizure and of 89 ones with epilepsy are compared. Results: No differences in age, gender, vascular risk factors, stroke type and aetiology, and post-ictal EEG are observed between both groups. The most significant difference is the time of seizure onset, with a low recurrence rate in patients with early- compared to those with late-onset after stroke. Patients with a primary generalised tonic-clonic insult and with a subcortical infarct are less at risk of seizure recurrence. Conclusions: The main consequences of these findings are that patients with early-onset seizures do not need sustained antiepileptic drugs (AEDs) after the acute treatment. Patients who develop late-onset seizures need AEDs after the first spell. (C) 2008 Elsevier B.V. All rights reserved.