The choice of anti-epileptic drugs in patients with poststroke seizures

Abstract

We evaluated the effects of treatment with anti-epileptic drugs (AEDs) in patients with post-stroke seizures. Of 690 stroke patients, we retrospectively examined 63 (9.1%) who received AEDs, most (74.6%) of whom had already begun AED administration at another clinic. The AEDs used as first-line monotherapy were sodium valproate (VPA) (n = 39, 61.9%), carbamazepine (CBZ) (n = 10, 15.9%), and zonisamide (ZNS) (n = 6, 9.5%), with others given to 8 (12.7%). Thirty-nine of the 63 patients (61.9%) were received AEDs after the initial attack, and twenty-four of the 63 patients (38.1%) were administered an AED as a prophylactic. The Japanese guidelines for treatment of epilepsy recommend that monotherapy should be started with CBZ for localization-related epileptic seizures. Post-stroke seizures are more likely to be partial seizures, thus CBZ should also be used for seizures after stroke. However, because of frequent and severe side effects, the use of CBZ might be avoided more often. Our sample size is small, and additional studies are needed to examine the use of AEDs after stroke to clarify guidelines for their administration, as well as their prophylactic use.