Vasileios-Arsenios Lioutas, MD

Post-stroke seizures, especially in the acute phase is a relatively well described and understood entity, but the incidence of post-stroke epilepsy, especially in the long term is far less thoroughly studied. In this interesting population-based study, Graham et al. investigate the epidemiology and associations of post-stroke epilepsy utilizing data collected over a 12-year period in the South London Stroke Register of first strokes.

Salient findings are the increase of epilepsy incidence with time from stroke (up to 12.4% at 10 years), as well as independent association of large, anterior circulation strokes and presence of signs of cortical involvement (dysphasia and visual neglect). These findings are on a par with conventional wisdom; one would expect large lesions with cortical involvement to lead to epilepsy as opposed to smaller, subcortical strokes. However, there are also less expected results, the most outstanding being an inverse association between age and post-stroke epilepsy incidence. The explanation offered by the authors – that younger patients are more likely to experience large, cortical infarcts – is more hypothetical than factual at this point and merits further in-depth study.

Despite several limitations, most importantly the fact that the diagnosis of epilepsy was self-reported and not confirmed by a physician, the study offers provides potentially useful information both for patients and physicians and more importantly underlines the need for prospective studies possibly including prophylactic antiepileptic treatment post-stroke.