Seizures and epilepsy after stroke Stroke Helpline: 0303 3033 100 or email: [email protected] This guide looks at post-stroke seizures and epilepsy, and how they can be diagnosed and managed. Seizures after stroke What is a seizure? A first seizure after stroke often occurs Cells in the brain send electrical signals to within the first few days, but it can happen one another. The electrical signals pass along two years or more after a stroke. You are your nerves to all parts of the body. A sudden more likely to have a seizure if you had a abnormal burst of electrical activity in the stroke caused by bleeding in the brain (a brain can lead to the signals to the nerves haemorrhagic stroke). being disrupted, causing a seizure. This electrical disturbance can happen because Seizures can also be more likely if you had of stroke damage in the brain. a severe stroke, or a stroke in the cerebral cortex, the large outer layer of the brain A seizure can affect you in many different where vital functions like movement, ways such as changes to vision, smell and thinking, vision and emotion take place. taste, loss of consciousness and jerking movements. For more information see If you have a seizure after a stroke, it does ‘Types of seizure’ later in this guide. not necessarily mean you have epilepsy, or will go on to develop it. Overall, your risk of having a seizure reduces over time after a Seizures and epilepsy stroke. Epilepsy is a condition that means you have Some people will have repeated seizures, repeated seizures. People can develop and be diagnosed with epilepsy. The chances epilepsy at any age, and in around half of of this happening may depend on where the all cases there is no obvious reason for it stroke happens in the brain, and the size of to happen. Epilepsy can be due to a brain the stroke. injury or other condition such as stroke, an infection or a growth in the brain. Overall, stroke is the cause in around 10% of adults newly diagnosed with epilepsy. For more information visit stroke.org.uk 1 Seizures and epilepsy after stroke Types of seizure How is epilepsy diagnosed? Seizures can vary, ranging from tingling A seizure may take place very soon after the sensations or ‘going blank’ for a few seconds, stroke. If you are in hospital at the time you to shaking and losing consciousness. Some should have help from the medical team on people have only one type of seizure, and the ward. If you have already left hospital and some have more than one type. think you have had a seizure, contact your GP. There are three main types of seizure. You should be referred to see a specialist within two weeks. The specialist is usually Focal onset seizures a neurologist, an expert in the brain and Some seizures only occur in part of the brain, nervous system. While you are waiting for the known as focal onset seizures. There are two appointment, it is best to avoid any activities kinds of focal seizures, motor (physical signs that could put you, or others, in danger if you like moving arms or falling), and non-motor have another seizure. For example, don’t go (affects senses, awareness and emotions). swimming, and have showers rather than a bath. You must not drive if you have had a Generalised onset seizures seizure. A generalised seizure involves the whole brain and affects the whole body. You may not be able to remember the Motor (physical) signs can include losing seizure, so if someone else witnessed it, they consciousness and muscle spasms. A non- could visit the specialist with you. Or they motor seizure could be a brief period of could send a written account or, if possible, absence or blankness, where the person a video of the seizure. It may help to keep stops moving, and looks as if they are staring a seizure diary recording the date and time into space. of your seizures, what happened and any possible triggers such as stress or drinking Unknown onset seizure alcohol. If it’s not possible to tell where the seizure began in the brain, doctors may describe The specialist will ask you questions about your seizure as motor or non-motor. what happened. This may be enough to Motor (physical) signs might include make a diagnosis. Further tests may be losing consciousness and having jerking needed, particularly if the seizure did not movements, and non-motor signs can affect involve convulsions. These tests do not prove emotions and sensations. whether you have epilepsy, but they can give information about the possible cause, and the type of epilepsy you have. 2 Call the Stroke Helpline on 0303 3033 100 Seizures and epilepsy after stroke Tests used in diagnosing epilepsy Anti-epileptic drugs (AEDs) Medication can usually reduce seizures and Electroencephalogram (EEG) allow you to lead a normal life. The treatment A common test for epilepsy is an EEG. It you have will depend on: is a painless test which involves placing electrodes on your scalp. These measure • What type of seizures you have. electrical activity in your brain, and can • Your age and sex. identify any unusual patterns. The test only • How frequent your attacks are. shows what is happening in your brain at • Other effects of your stroke, like the time it is done, so a normal EEG does swallowing problems. not necessarily mean that you do not have • Other medication you are taking. epilepsy. There are several different types of An EEG usually takes about one hour and can medication available for epilepsy. These be done at an outpatient clinic. are called anti-epileptic drugs or AEDs. They usually work by changing the levels of Magnetic resonance imaging (MRI) chemicals in the brain. An MRI scan can find problems inside the brain which might cause epilepsy, including In some cases the normal activity of the brain the damage left by a stroke. may also be affected, leading to drowsiness, dizziness, confusion and other side effects. Blood tests Once your body is used to the medication, You may be given blood tests or have other these side effects may go away. checks to look for health problems that can Your doctor might start you on a low dose cause similar symptoms, such as diabetes, and increase it gradually to reduce the migraine and panic attacks. chances of you having side effects. If they are severe or last a long time, your doctor may change the dose or try a different medication. How is epilepsy treated? Everyone is different, and some people Treatments for epilepsy include: experience side effects from a particular medication even at a low dose. However, you • Anti-epileptic drugs (AEDs). can usually try a different type if his happens, • Surgery. as there are many safe and reliable AEDs • Vagus nerve stimulation therapy. available. • Ketogenic diet. You might be given a single drug or a This guide can only give general combination of two or more. The type you information. You should always get are given depends on the type of seizures, individual advice about your own health and any side-effects you have from a and any treatment you may need from particular drug or combination. a medical professional such as a GP or pharmacist. If you have symptoms like feeling unsteady, having poor concentration or vomiting, your dose could be too high and you should contact your GP or specialist. For more information visit stroke.org.uk 3 Seizures and epilepsy after stroke Surgery First aid for seizures Surgery may be an option if anti-epileptic drugs do not help you, and if your epilepsy is What you can do if someone is unconscious due to a physical cause in your brain, such as and making jerking movements. scarring or stroke damage. Whether you can have surgery depends partly on where the • Protect the person from injury by removing problem lies inside your brain, and whether any harmful objects nearby and cushioning a surgeon can reach it safely. Having surgery their head. in your brain can be very risky. You can work • Loosen any tight clothing from around with your doctor to understand the risks and their neck. possible benefits to you before choosing to • Look for any identity card or jewellery that go ahead. might give you advice on what to do. • Do not attempt to restrain the person or Vagus nerve stimulation therapy bring them round. A small electrical device is implanted in the • Do not move them, unless they are in neck, and connects to the left vagus nerve. danger. The device sends regular electric signals to • Do not put anything into their mouth. the brain via the vagus nerve, which can help • After the seizure has finished, turn them regulate electrical activity in the brain that on their side to help them breathe more causes epilepsy. easily. • Do not give them anything to eat or drink. Ketogenic diet • Be calm and reassuring, stay with them This treatment is used for children (and until they have completely recovered. occasionally adults) who don’t respond • Make a note of how long the seizure to AEDs, and involves a high-fat, low- lasted. carbohydrate diet. This changes the way the brain uses energy, which may reduce Call 999 if: seizures. It should only be used with the help of a specialist doctor and dietician. • One seizure follows another without the person recovering in between. • The seizure continues for more than five minutes.