SEIZURESFROMSTROKES

Strokesandseizures.Bothcanbeverydisturbing,butdotheyhaveanythingelseincommon?

Peoplesometimesconfusestrokesandseizures,buttheyaretwoverydifferentconditions. First,herearesomebasicsabouteach.Astrokeresultsfromreducedbloodflowtoallorsome partofthebrain,inturnleadingtothedeathofsomebraincells.Meanwhile,aseizureisthe resultofexcessive,synchronouselectricalactivityinbraincircuits.Eventually,abrainaffected byaseizurewillrecover.Aseizuremayappearmoredramaticandupsetting,butastrokeis medicallymuchmoreseriousbecauseinstrokebraincellsdie. Sohowarestrokesandseizureslinked?Firstofall,strokesandseizuresarecommonandsome peoplecanactuallyhaveboth.Anythingthatinjuresthebrain,includingstrokes,canleadlater toseizures.Inaddition,strokesandtransientischemicattacksorTIAs,,whicharesometimes calledwarningstrokes,canbemistakenforseizures. Aseizurealsocanimitatestroke.However,itisimportanttonotethatseizuresalmostnever causestrokes.However,abodypartthatisinvolvedinaseizuremaybetemporarilyweakor paralyzedandthiscanlooklikeastroke.TemporaryparalysispostseizureiscalledTodd's paresis.Onrareoccasions,about2to5%ofthetime,astrokewillleadtooneormoreseizures. Ifseizuresoccurwithinaweekofastroke,thenitiscalledanacutesymptomaticseizureandis notdiagnosedasbeingepilepsy.Aseizurethatoccursmorethanaweekafterastrokedoes raisethequestionofpossibleepilepsy.Twomoreseizurespoststrokeisdefinitelyepilepsy. Sometypesofstrokesaremorelikelythanotherstoproduceseizures,suchasbleedinginthe brainoratravelingbloodclotcalledanembolusthatblocksabrainartery. Epilepsythatfollowsastrokesometimescanbedelayedevenmonthsoryearsafterthestroke. Thismaybebecauseascircuitsinthebrainhealandreconnectovertime,theybecomemore

RobertS.Fisher,M.D.,Ph.D.,MaslahSaulMDProfessorofNeurology,Stanford,EditorinChief,epilepsy.com

SEIZURESFROMSTROKES

hyperexcitable,makingthebrainmorepronetoseizures.Importantly,aseizuredoesnotmean thatthepersonishavinganotherstroke.

Whenepilepsyoccurslaterinlife,itmaystemfrompriorstrokes,evenverysmallonesofwhich thepersonisnotaware.WhilescarsfromthesesmallstrokesmaybevisibleonanMRI,thereis noeasywaytoknowwhich,ifany,ofthescarsiscausingtheseizures. Treatmentofseizurescausedbystrokesissimilartotreatmentofanypartialseizure.Itusually involvesantiepilepticmedications.Ofcourse,preventingafuturestrokeisalsoveryimportant. Moreinformationcanbeobtainedfromyourdoctororbysearchingthewebforstroke preventioninformation.Ifyouorsomeoneyoucareaboutmaybehavingseizuresorstroke symptoms,pleasecontactaphysician.

RobertS.Fisher,M.D.,Ph.D.,MaslahSaulMDProfessorofNeurology,Stanford,EditorinChief,epilepsy.com