Post Stroke Epilepsy (PSE)
Posted on
September 6, 2024
Let's learn all the facts about a brain pattern called
Post Stroke Epilepsy (PSE)
!
Post Stroke Epilepsy (PSE)
Yamada, Thoru, and Elizabeth Meng. Practical Guide for Clinical Neurophysiologic Testing: EEG. Available from: Wolters Kluwer, (2nd Edition). Wolters Kluwer Health, 2017.
https://doi.org/10.1212/WNL.0000000000209450
Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management - PMC (nih.gov)
Strokes happen when the blood supply to a part of the brain is cut off. A stroke can have traumatic and catastrophic consequences not only for the stroke sufferer, but for their families and loved ones as well. Depending on its severity, a stroke can impair movement, sensation, communication, memory, and emotion.
Scar tissue formed in brain areas damaged by strokes send out abnormal electrical signals. (Scar tissue from any cause can do this.) This electrical activity can trigger different types of seizures based on where it starts and how it spreads. Seizures can range from focal (with or without loss of awareness) to focal with secondary generalization (also called focal to bilateral seizures). These seizures first start in the stroke area then spreads to involve the entire brain.
It varies from 24 hours after a stroke to weeks, months, or even years. Around 43% of people who experience post-stroke seizures have done so within 24 hours of their stroke. Stroke is the most common cause of seizures in adults older than 60 in the US. Nearly 10% of stroke survivors suffer from post-stroke seizures.
Poststroke epilepsy (PSE) is associated with higher mortality and poor functional and cognitive outcomes in patients with stroke. Approximately 10% of patients with stroke develop PSE and is a significant problem in stroke survivors.
In general, the EEG abnormalities identified in stroke patients depend on the location and size of the infarction. For most cortical strokes, the EEG will show focal slowing and occasionally sharp waves. Lateralized periodic discharges (LPDs) can occur after acute cortical stroke but generally disappear within days. Brainstem infarctions can result in significant slowing of the background and alteration of reactivity. Subcortical/lacunar strokes often show no change on EEG. Locked-in states following pontine infarction are usually associated with normal background activity or mild scattered slowing on EEG. The background is typically reactive.