Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Epilepsy after stroke In the first few weeks after a stroke some people have a seizure, and a small number go on to develop epilepsy – a tendency to have repeated seizures. These can usually be completely controlled with treatment. This factsheet explains what epilepsy is, the different types of seizures, and how epilepsy is diagnosed and treated. It also includes advice about coping with a seizure, and a glossary. Epilepsy is a tendency to have repeated What causes seizures? seizures – sometimes called ‘fits’ or ‘attacks’. It affects just under one per cent Cells in the brain communicate with one of people in the UK. Stroke is one of many another and with our muscles by passing conditions that can lead to epilepsy. electrical signals along nerve fibres. If you have epilepsy this electrical activity can Around five per cent of people who have a become disordered. A sudden abnormal stroke will have a seizure within the following burst of electrical activity in the brain can few weeks. These are known as acute or lead to a seizure. onset seizures and normally happen within 24 hours of the stroke. You are more likely There are over 40 different types of seizures to have one if you have had a severe stroke, ranging from tingling sensations or ‘going a stroke caused by bleeding in the brain (a blank’ for a few seconds, to shaking and haemorrhagic stroke), or a stroke involving losing consciousness. the part of the brain called the cerebral cortex. If you have an onset seizure, it This can mean that epilepsy is sometimes does not necessarily mean you have or will confused with other conditions, including develop epilepsy. stroke. If you experience symptoms like tingling, you may worry that you are having A small number of people will have more than another stroke or transient ischaemic one seizure and will develop epilepsy. attack (TIA – sometimes called a mini stroke). This may be a seizure and not a Your risk of having a seizure lessens with time stroke, but if you experience symptoms like following your stroke. If you have recovered tingling, you should seek medical attention and have not yet had a seizure, you are at straightaway. very low risk of developing epilepsy. Stroke Association – September 2012 1 Epilepsy after stroke Types of seizures There are several other types of generalised seizures: Partial seizures • tonic seizures – where your muscles Some seizures only occur in part of the go suddenly stiff but you do not have brain. These are called partial or focal convulsions seizures. You may remain conscious and aware of your surroundings during a partial • clonic seizures – where you have seizure (called a simple partial seizure) or you convulsions but no muscle stiffness may become confused and unable to respond beforehand (a complex partial seizure). The symptoms you experience during a partial seizure will • atonic seizures – where you suddenly lose depend on which part of your brain has been all muscle tone and go limp affected. Possiblesymptoms include: • myoclonic seizures – where you • Changes in sensation such as a tingling experience a brief muscle jerk similar to feeling, which spreads to other parts of the jerk you sometimes get as you fall your body – commonly people experience asleep. a rising feeling in their stomach (a bit like when you go over a humpback Sometimes a partial seizure can spread to bridge). This is called an epigastric rising both sides of the brain. This is known as a sensation. secondary generalised seizure. Stroke onset seizures are often of this type. • Uncontrollable stiffness or twitching in a part of the body such as your arm or hand. Most seizures stop by themselves and last between two and five minutes. After • Disturbances in your vision, such as a seizure you may feel tired or confused. seeing flashing lights. The time it takes to recover varies from person to person. Sometimes after a Generalised seizures seizure associated with stroke, you will have temporary weakness, which may feel very Generalised seizures involve both the similar to your stroke. This is called Todd’s left and right side of the brain. The most paralysis or Todd’s paresis and it may last for common and widely recognised type is a a few hours. tonic-clonic seizure. In this type of seizure, you lose consciousness, your muscles go Status epilepticus stiff and you usually fall backwards. After this, your muscles tighten and relax in turn, Status epilepticus is a seizure that lasts for causing your body to jerk (convulse). Your 30 minutes or longer, or a series of seizures breathing may become difficult and you may without consciousness being regained in- lose control of your bladder. This convulsive between. phase of the seizure should only last a minute or two. During these seizures, your body struggles to circulate oxygen properly, so status 2 Stroke Association – September 2012 Epilepsy after stroke epilepticus is an emergency. Call 999 if you How is epilepsy treated? witness someone having a seizure that lasts for more than five minutes or if one seizure You will not normally be treated for a single follows another without them regaining seizure that has happened soon after consciousness in-between. your stroke, but you may be prescribed medication if you have any more. How is epilepsy diagnosed? There is currently no cure for epilepsy, but If you are not in hospital and you think you medication can usually prevent seizures have had a seizure you should see your GP. and allow you to lead a normal life. Which You should be referred to see a specialist as treatment you have will depend on: soon as possible. • what type of seizures you have had You may not be able to remember the seizure so if someone else witnessed it, it might • how frequent your attacks are help if they see the specialist with you. The specialist will ask you questions about what • other effects of your stroke like happened. This may be enough to make a swallowing problems diagnosis. However further tests may be needed, particularly if the seizure did not • other medication you are taking. involve convulsions. There are several different types of A common test for epilepsy is an medication available for epilepsy. These are electroencephalogram (EEG). It is a painless called anti-epileptic drugs or AEDs. They test which involves placing electrodes usually work by preventing the excessive on your scalp. These measure electrical build up of electrical activity in the brain activity in your brain and can identify any which causes seizures. Unfortunately, the unusual patterns. The test only shows what normal activity of the brain may also be is happening in your brain at the time it is affected, leading to drowsiness, dizziness, done, so a normal EEG does not necessarily confusion and other side effects. Once your mean that you do not have epilepsy. An EEG body is used to the medication, these side test usually takes about one hour and can be effects may go away. Your doctor may start done at an outpatient clinic. you on a low dose and increase it gradually to reduce the chances of you having side It may help to keep a seizure diary recording effects. If they are severe or last a long time, the date and time of your seizures, what your doctor may change the dose or try a happened and any possible triggers. For different medication. example, some people find that drinking alcohol or being under stress can trigger Everyone is different and some people a seizure. Flashing lights are a trigger experience side effects from a particular for people with a type of epilepsy called medication even at a low dose. However photosensitive epilepsy, though this only you can usually try a different type if this affects a small proportion of people with happens, as there are many safe and reliable epilepsy. AEDs available. Stroke Association – September 2012 3 Epilepsy after stroke The drugs used to treat epilepsy are often • loosen any tight clothing from around referred to as first-line and second-line their neck drugs. First-line drugs were developed first and have been used to treat epilepsy for • do not attempt to restrain the person or many years, whereas second-line drugs are bring them round much newer. • do not move them, unless they are in First-line drugs are usually the first choice danger of treatment to control seizures. Examples include sodium valproate, carbamazepine, • do not put anything into their mouth phenytoin, phenobarbital and primidone. • after the seizure has finished, turn them Second-line AEDs are usually recommended on their side to help them breathe more if there is a reason why you cannot take easily one of the first-line drugs, for example if it interacts with other medication you • do not give them anything to eat or drink are taking. Examples include gabapentin, lamotrigine, levetiracetam, oxcarbazepine, • be calm and reassuring, stay with them tiagabine, topiramate and vigabatrin. until they have completely recovered Driving • make a note of how long the seizure lasted. If you have had a seizure, you must stop driving and notify the DVLA (England, Call 999 for an ambulance if: Scotland and Wales) or the DVA (Northern Ireland) as well as your insurance company. • one seizure follows another without the If, and when you can start driving again will person recovering in-between depend on the type and frequency of your seizures and the kind of licence you hold. For • the seizure continues for more than five more information about driving regulations, minutes, or the person is unconscious for see our factsheet F2, Driving after stoke.