Post-stroke Seizures

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  • November 20, 2011
Photo from the Internet Stroke Center

According to the website of the Internet Stroke Center, the World Health Organization’s (WHO) latest statistics estimated that every year there are about 15 million people who had experienced a stroke. It is also estimated that of these large number of stroke victims, at least 5 million succumb to their stroke and that at least another 5 million people are left with permanent disability.

A stroke victim can be left with one or several disabilities depending on the gravity inflicted by their stroke such as problems with mobility, speech, logic and others can arise after a person experiences a stroke.  These disabilities target certain parts of the body – the face, the upper extremities, the lower extremities, etc.  However, what is not seen by other people is that the stroke has a lasting imprint on the brain of the stroke victim.

Aside from the noticeable disabilities identified another potential problem patients and caregivers should be wary about are seizures and epileptic attacks after their stroke. Among the elderly, experiencing a previous stroke is the usual cause of experiencing a seizure attack in the future.

What are seizures?
The brain works in a systematic way. It receives data from our five senses (sight, smell, touch, hearing and taste), collects these data, analyzes them and then sends out corresponding “reactions” back to our five senses.  However, during a seizure, the electrical activity in the brain becomes disorganized which causes a person’s body to spasm. Instead of giving out the correct message (reactions) to specific body parts, the brain is now causing the body to spasm.

There are two types of seizures: those which can happen spontaneously (primary seizures) and those which are caused by damage to the brain, usually a stroke (post-stroke seizure).

The National Institutes of Health (NIH) of America estimates that at least 11.5% of stroke patients are at risk of developing post-stroke seizures. These seizures can happen immediately after the stroke or may lie dormant for up to 5 years, thus the term post-stroke seizures.

Seizures after a stroke
A post-stroke seizure can either be a single episode or multiple convulsive episodes regardless of when the seizure initially occurred. It is related to either a reversible or irreversible damage to the frontal part of the brain, the cerebrum. It is different from and should not be confused with post-stroke epilepsy. Post-stoke epilepsy, on the other hand, are also recurrent seizures after a stroke but they are confirmed by healthcare providers with a diagnosis of epilepsy. The only difference between the two is that post-stroke epilepsy had been diagnosed and had been confirmed by a physician.

Post-stroke seizures are either classified as early or late onset. Early onset seizure occurs as early as 24 to 48 hours after the stroke up to 14 days after the stroke. Late onset seizures occur after two weeks of the initial onset of the stroke.

The NIH affirmed that post-stroke seizures and post-stroke epileptic episodes are the most common causes of hospital admissions. They consider these seizures as a complication of their previous stroke. These seizures are not a recent development brought about by their increased age but as a result of their stroke.

Some studies had observed that patients who had suffered an ischemic stroke were 10% more likely to experience a seizure after their stroke and that they could experience at least one seizure up to the 5th year post-stroke. Hemorrhagic stroke patients fared worse than ischemic stroke patients, the risk of seizures post-stroke ranged from 27% up to 34%.

What to do during a seizure
There is a saying that “Knowing is half the battle” and knowing what to do when faced with the dilemma of a loved one having a seizure after a stroke is the best “remedy.”

If a person you know or a stranger you just met suddenly experiences a seizure while you are outside of the house or if the person is in a standing position:

  1. You can try to help that person by slowly placing him or her on the ground.
  2. If there are other people who can lend a hand, let them call the nearest hospital or ambulance for help.
  3. The next thing to do is to try to keep the space around the person experiencing a seizure free from unnecessary objects. Since the person experiencing a seizure may experience some jerky movements, stray objects may fall and hit the person.
  4. If you could guide the person into a recovery (side-lying) position, then do so. This prevents saliva and other oral secretions from causing unnecessary blockage of the person’s airway. It also keeps the tongue from obstructing the breathing of the person experiencing a seizure.
  5. If you can’t place the person in a side-lying position while the seizure is happening, you may wait until the seizure stops and then place the person in the recovery position.
  6. If there were no other people besides the two of you when the seizure happened, now is the best time to call for medical help.

If the seizure happened while the person is in bed:

  1. Try to place a pillow underneath the person’s head to keep the head from banging into the bed.
  2. Again, if there are other people around, let them call the ambulance ASAP.
  3. Keep the bed from unnecessary objects which may fall on the person.
  4. Again, try to place him or her in a recovery/side-lying position

Keep in mind
Remember to never place any hard object such as a spoon or a stick into the person’s mouth while he or she is experiencing a seizure. Previously, such practice was done to prevent the person who is having a seizure from cutting his or her tongue with his or her teeth. It has been proven otherwise.  Such practice would only cause more harm than good. Spoons and other hard objects were eventually broken in half by the biting motion of the mouth during a seizure. These objects were found to either cause oral lacerations or even worse blocking the airway of the person. The best thing to do is to let the seizure run its course and place the person in a recovery position if possible.

Also, never try to hold on to the extremities of the person experiencing the seizure. In the past, such practice was done to prevent the person from hitting other people and objects around him. However, such practice had been deemed as unnecessary, again, since it can cause more harm than good. Holding the person’s arms and legs can lead to fractures if the person holding the extremities is not knowledgeable on where to properly place his or her hands on the person having a seizure. Again, the best thing to do is to let the seizure cease on its own and have the person undergo a thorough evaluation by his or her doctor.

Postgraduate Medical Journal
Archives of Neurology



  • Leslie Nanasy says:

    Thank you for providing information about post stroke seizures. I experienced a grand mal seizure after having an ischemic stroke at age 45. The seizure occurred 9 months after my stroke and was totally unexpected. I bit my tongue so hard during the seizure that I had to be intubated in order to breathe and fed with a tube in my nose while I was in the ICU for 3 weeks. It was a painful and horrifying experience. Fortunately with anti-seizure medication, I have not experienced any other seizures. In looking back at my post-stroke care, I wish I had been given anti-seizure medication, but I had no knowledge of this possibility and my doctors told me post-stroke seizures were very uncommon so they didn’t believe I should be given any anti-seizure medication after my stroke. Thank you for getting out information on post-stroke seizures. I can assure you they are a very real possibility.

  • Balu says:

    Are the post stroke seizures are permanently curable?
    Thanks in advance for your response.

  • fsanchez says:

    Dear Balu,

    I would like to inform you that we are not a medical center or clinic and we are unable to provide medical care or advice/diagnosis. We can advise on how NeuroAiD can help in a stroke recovery based on the medical profile and history of the patient.
    Based on our experience, none of our patients has permanently got cured on seizures. However, it would be best to consult a neurologist on this matter.

  • Craig A> Fox says:

    What is likelihood of seizure 4 years after ischemic stroke. Patient had 1 seizure due to brain tumor, now removed. No other symptoms

  • Marcie Stoppel says:

    What is likelihood of seizure 8 years after hemorrhagic stroke. I am 84 years old and my EEG shows abnormal activity and my neuoroligist want me to go on medication for seizures.

  • Sally Marks says:

    My mother had an ischemic stroke 2.5 yrs. ago, and has had 4 seizures in that time span. Each lasts about 5 minutes. The first one was about 9 months after the stroke. At this time, her doctor doesn’t want to put her on medication.

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