Post-epilepsy stroke: A review

ABSTRACT

Stroke and epilepsy are two of the most common neurological disorders and share a complicated relationship. It is well established that stroke is one of the most important causes of epilepsy, particularly new-onset epilepsy among the elderly. However, post-epilepsy stroke has been overlooked. In recent years, it has been demonstrated that epilepsy patients have increased risk and mortality from stroke when compared with the general population. Additionally, it was proposed that post-epilepsy stroke might be associated with antiepileptic drugs (AEDs), epileptic seizures and the lifestyle of epileptic patients. Here, we comprehensively review the epidemiology, causes and interventions for post-epilepsy stroke.

KEYWORDS:

• Epilepsy
• stroke
• antiepileptic drugs (AEDs)
• lifestyles
• interventions

Financial and competing interests disclosure

This work was supported by the National Clinical Key Specialty Construction Foundation of China and the National Natural Science Foundation of China [grant number 81471320]. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• The relationship between epilepsy and stroke is complicated. Stroke has been viewed as one of the most important causes of epilepsy. However, the stroke after epilepsy (or postepilepsy stroke) does not get enough attention in clinical practice.

• Various epidemiological studies showed that there was a higher risk of stroke and increased mortality from stroke in epilepsy patients. The increased risk of stroke is associated with the type, the dose, the duration of antiepileptic drug (AED) exposure. Combination of AEDs may increase the risk of stroke.

• The causes of postepilepsy stroke remain unclear. It has been proposed that the side effects of AEDs, epileptic seizures themselves, or the lifestyles of epilepsy patients may contribute to the development of postepilepsy stroke.

• It is essential to monitor stroke risk factors, such as blood pressure, total cholesterol levels, lamotrigine levels, low-density lipoprotein-cholesterol levels, high-density lipoprotein cholesterol levels, weight, glucose, insulin, homocysteinemia, uric acid levels, and thyroid hormone levels in epilepsy patients. Once any of the risk factors is found in the epilepsy patients, it is strongly suggested that the appropriate medication be given as primary prophylaxis of stroke.

• Considering the positive effects of healthy dietary choices, regular exercise, and smoking cessation on the risk of stroke, epilepsy patients should be advised to change their lifestyles.

• Appropriate AEDs should be given to the epilepsy patients with metabolic syndromes. For example, non-enzyme-inducing-AEDs are recommended for epilepsy patients with lipid abnormalities; valproic acid, carbamazepine, phenytoin, gabapentin, vigabatrin, and pregabalin should be avoided in obese epilepsy patients.

Additional information

Funding

this work was funded in great part by national science foundation grant no. 0732233, “learning progressions for scientific inquiry: a model implementation in the context of energy.”