Taking Anti-Seizure Medications After a Stroke

Seizures are episodes of involuntary movement or changes in consciousness or both. They are caused by erratic brain activity. Seizures can happen spontaneously or as a result of brain damage, such as head injuries, brain tumors, or strokes.

Some of the symptoms of strokes and seizures may be similar, which can be confusing if you have already had a stroke. It helps if you can learn to recognize the differences and similarities between strokes and seizures.

A woman having a seizure.
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How Common Are Seizures After a Stroke?

Your doctor may discuss seizure prevention with you after you have had a stroke because seizures are not uncommon after a stroke.

Approximately 10% of all ischemic stroke survivors experience at least one seizure within five years after their stroke. The risk of a seizure after a hemorrhagic stroke is even higher. Approximately 27% of patients with intracerebral hemorrhage and 34% of patients with subarachnoid hemorrhage experience at least one seizure within five years after their stroke.

Stroke survivors who experience a stroke that injures the outermost part of the brain (the cerebral cortex) are the most likely to experience a seizure after the stroke.

How Common Is Epilepsy After a Stroke?

Epilepsy is a condition characterized by a tendency to have repeated seizures. The incidence of new-onset epilepsy after a stroke is much lower than the incidence of having one or two seizures.

Epilepsy after stroke is reported to occur in only 2% to 4% of stroke survivors. Yet, as a whole, stroke is the most commonly identified cause of epilepsy in adults older than 35, and accounts for more than 50% of all new cases of epilepsy of known cause in the elderly population.

What a Seizure Looks Like

There are different types of seizures. Typically, people think of seizures as episodes of loss of consciousness, shaking of the legs and arms, tongue biting, and bowel or bladder incontinence. This type of seizure, commonly called a generalized tonic-clonic seizure, is one of several seizure types.

Other types are much more subtle and can be extremely difficult to identify by an observer. For instance, petit mal seizures make people stare quietly into space, while gelastic seizures are characterized by involuntary laughter.

Medications Used to Treat Stroke-Related Epilepsy

There are a number of medications that are effective in controlling seizures. Stroke-related epilepsy can typically be controlled well with anti-epileptic drugs (AEDs)—but these medications may not be warranted in all cases. Your doctor can determine whether AEDs are necessary for your specific condition based on several factors, including your risk of seizure recurrence and the likelihood of drug interactions with any other medications you are taking.

First-line treatment drugs for stroke-related epilepsy come from the class of newer-generation AEDs, such as:

  • Lamictal XR, Lamictal ODT (lamotrigine)
  • Horizant, Gralise, Neuraptine (gabapentin)
  • Keppra XR, Spritam, Roweepra (levetiracetam)

These medications have a good safety profile and an impressive rate of long-term, seizure-free periods. First-generation AEDs, such as phenytoin, carbamazepine, and phenobarbital, in contrast, tend to come with higher risks and more pronounced side effects.

Clinical Guidelines on Anti-Epileptic Drugs After Stroke

Clinical guidelines published jointly by the American Heart Association and American Stroke Association recommend against the use of anti-epileptic drugs in most patients as a preventive measure against seizures after stroke. The guidelines note that prescribing a new anti-epileptic drug carries a significant risk of side effects and may even be associated with poorer overall outcomes.

Complications with Taking Anti-Seizure Medications After a Stroke

Some people continue to have seizures in spite of taking their medications. The reasons for continued seizures include:

  • Inadvertently missing doses: Some people forget to take their medicines. This is especially problematic when someone develops memory problems from a stroke and inadvertently, but frequently, skips doses. In these cases, the help of a caregiver is essential not only to ensure appropriate treatment with anti-seizure medications but also with other medicines.
  • Intentionally skipping doses: Some people experience unwanted side effects from their anti-epileptic medicines and decide to skip doses to avoid them. If you develop side effects from your medicines, it is very important that you talk to your doctor about it before you decide to skip a dose so that you can have your medication changed or your dose adjusted.
  • Lack of sleep: For reasons that are not completely understood, people who suffer from epilepsy are more likely to have a seizure when they are sleep-deprived. Some stroke survivors have abnormal sleep patterns due to brain damage, depression, or both. If you are sleep-deprived from depression or from any other cause, and you are also having seizures in spite of taking your medications, talk to your doctor about it.
  • Alcohol: Alcohol increases the likelihood that someone will have a seizure. If you have epilepsy, doctors recommend avoiding alcohol completely.
  • Insufficient dose of AEDs: While there are recommended doses for all medications, everyone is unique, and you may need a slightly higher or lower dose for optimal seizure control and avoidance of side effects. If you continue to experience seizures, discuss with your doctor so that you can have your medication changed or adjusted as needed.
  • Worsening epilepsy: Epilepsy can get worse over time, regardless of whether or not you take your medicines. In such cases, it is extremely important to change medicines, increase doses of existing medicines, or add a second or third medicine to your regimen. Among the options, your doctor may suggest that you get evaluated for surgery to control your seizures. To assist your doctor, keep a seizure diary and bring it with you to each doctor's visit. This simple tool can be of great value in evaluating whether or not you need changes in your medication regimen.

A Word From Verywell

Seizures can develop as a consequence of a stroke, but the development of epilepsy, a condition marked by repeated seizures, is much less common. Your doctor may prescribe AEDs to manage post-stroke seizures, but taking new AEDs may take some getting used to.

If you or your loved one is taking AEDs to stop post-stroke seizures, it is important to maintain communication with your healthcare team so that you can have optimal seizure control and minimal side effects.

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Article Sources
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