Epilepsy And Strokes: Understanding The Link And Risks

Epilepsy and strokes are both medical emergencies that affect the brain and can be difficult to tell apart. While a stroke occurs when there is a lack of blood flow to a certain part of the brain, epilepsy is a neurological disorder characterised by recurrent seizures with no apparent cause. Although the two conditions are distinct, they are linked in several ways. Studies have shown that epilepsy can increase the risk of a subsequent stroke, with older patients facing a threefold risk. On the other hand, strokes are a common cause of epilepsy, especially in adults, with around 10% of newly diagnosed cases attributed to stroke damage in the brain.

Epilepsy patients have a higher risk of stroke

It is well-established that epilepsy patients are at an elevated risk of suffering a stroke. This risk is especially pronounced in younger patients and those taking high doses of anti-epileptic medication. The onset of seizures in late life is also associated with a heightened risk of stroke.

The Link Between Epilepsy and Stroke

Epilepsy is a condition that causes repeated seizures, which are sudden bursts of electrical activity in the brain. A stroke, on the other hand, occurs when there is a blockage in a blood vessel or bleeding in the brain, resulting in a lack of blood flow to specific areas of the brain. While epilepsy and stroke are distinct conditions, they are interconnected in several ways.

Firstly, cerebrovascular disease is considered a major cause of epilepsy in older individuals. In other words, the onset of seizures after the age of 60 may be an indicator of an increased risk of subsequent stroke. A study by Cleary et al. found that epilepsy onset later in life carries a threefold risk of stroke.

Secondly, stroke is a recognised cause of epilepsy. Approximately 10% of adults newly diagnosed with epilepsy have stroke as the underlying cause. This is due to the brain damage caused by the stroke, which can lead to disorganised electrical activity and subsequent seizures.

Risk Factors and Prevention

Several factors can increase the risk of stroke in epilepsy patients. These include younger age, higher doses of anti-epileptic medication, and the onset of epilepsy later in life. Additionally, certain types of strokes, such as haemorrhagic strokes or those affecting the cerebral cortex, are more likely to lead to seizures and epilepsy.

To mitigate the risk of stroke, epilepsy patients should consider the following:

• Regular screenings for conditions such as high blood pressure, diabetes, and high cholesterol
• Maintaining a healthy weight
• Adopting a healthy diet
• Engaging in regular physical exercise

Treatment Options

The treatment for epilepsy-related strokes typically involves the use of anti-seizure medications, which can help regulate electrical activity in the brain. In some cases, epilepsy surgery or electrical stimulation therapies may be recommended for patients who do not respond to medications. Additionally, stroke-related epilepsy can often be fully controlled with anti-seizure medications.

Strokes can cause epilepsy

Epilepsy is a condition that causes repeated seizures. People can develop epilepsy at any age, and in around half of all cases, there is no obvious reason for it to happen. However, epilepsy can be due to a brain injury or other conditions such as a stroke, an infection, or a growth in the brain.

Seizures are most likely to happen within the first few days following a stroke, but they can also occur two or more years later. The chances of developing epilepsy depend on where the stroke occurs in the brain and the size of the stroke. If you have a seizure after a stroke, it does not necessarily mean you will develop epilepsy. Overall, the risk of having a seizure reduces over time after a stroke.

You are more likely to have a seizure if you have had a haemorrhagic stroke (bleed on the brain), a severe stroke, or a stroke in the cerebral cortex, the large outer layer of the brain where vital functions like movement, thinking, vision, and emotion take place.

If you have had a seizure, you must, by law, stop driving and notify the relevant authorities and your insurance company.

Seizures are a symptom of strokes

Seizures can occur within the first few days of a stroke, or even up to two or more years later. They are more likely to happen if the stroke was severe, caused bleeding in the brain (a haemorrhagic stroke), or occurred in the cerebral cortex—the large outer layer of the brain responsible for vital functions like movement, thinking, vision, and emotion. The risk of having a seizure after a stroke decreases over time.

While epilepsy is often associated with post-stroke patients, not everyone who has a seizure after a stroke will develop epilepsy. Epilepsy is characterized by recurrent seizures with no apparent cause. If you have recovered from a stroke and have not had any seizures, your risk of developing epilepsy is very low.

The occurrence of seizures after a stroke depends on the location and size of the stroke. Seizures can range from tingling sensations or 'going blank' for a few seconds to shaking and losing consciousness. They can also manifest as changes in vision, smell, or taste.

If you experience a seizure, it is important to seek medical attention and stop certain activities, such as driving, swimming, or cooking, that could put you or others in danger if another seizure occurs.

Epilepsy is a warning sign of stroke

While epilepsy and stroke are distinct conditions, they are closely linked. Epilepsy can be a warning sign of an impending stroke, and it is important to recognise this to prevent or mitigate the effects of a stroke.

Epilepsy as a Risk Factor

Epilepsy is a neurological condition characterised by recurrent seizures, often with no apparent cause. Seizures are caused by a sudden burst of electrical activity in the brain, which disrupts the normal electrical signals sent between brain cells. This can lead to a range of symptoms, including jerking movements, loss of consciousness, changes in vision, smell and taste, and unusual behaviours.

Studies have shown that epilepsy, particularly when it occurs later in life, is a significant risk factor for stroke. Research has found that the onset of seizures after the age of 60 is associated with an increased risk of stroke. This risk is estimated to be almost three times higher than that of the general population, with epilepsy patients exhibiting a higher incidence of cerebral stroke specifically.

The Link Between Epilepsy and Stroke

The link between epilepsy and stroke is complex and not yet fully understood. While epilepsy can be a warning sign of stroke, it is also commonly a result of stroke. Stroke is the cause of epilepsy in around 10% of adults newly diagnosed with the condition. This is because stroke damage in the brain can cause electrical disturbances, leading to seizures.

Additionally, the lack of blood flow during a stroke can interfere with electrical signals in the brain, triggering seizures. This can happen at the start of a stroke or in the days following it. As the brain heals from a stroke, it can also develop scar tissue, which may interfere with electrical activity and lead to seizures up to two years or more after the stroke.

Recognising the Warning Signs

Given the strong link between epilepsy and stroke, it is crucial to recognise epilepsy as a warning sign of an impending stroke. Seizures in older individuals, particularly those with no known cause, should be treated with the same urgency as a transient ischaemic attack (TIA), a temporary interruption of blood flow to the brain.

Further research is needed to determine the most effective interventions to prevent stroke in patients with epilepsy. However, it is clear that early warning signs are critical to preventing or mitigating the effects of a stroke. Therefore, epilepsy should be added to the list of risk factors for stroke, alongside cholesterol, cardiac disease, smoking, hypertension, diabetes, and weight control.

By recognising epilepsy as a warning sign of stroke, individuals, and healthcare professionals can take appropriate steps to reduce the risk of stroke and improve patient outcomes.

Stroke survivors may experience seizures

Some stroke survivors can experience seizures. These are most likely to happen within the first few days following a stroke, but a first seizure could occur two or more years later.

Risk Factors

You're more likely to have a seizure if you've had a severe stroke, a stroke caused by bleeding in the brain (a haemorrhagic stroke), or a stroke in the cerebral cortex—the large outer layer of the brain where vital functions like movement, thinking, vision, and emotion take place.

What to Do if Someone Is Having a Seizure

• Protect the person from injury by removing any harmful objects nearby and cushioning their head.
• Loosen any tight clothing from around their neck.
• Look for any identity card or jewellery that might give you advice on what to do.
• Do not attempt to restrain the person or bring them around.
• Do not move them unless they are in danger.
• Do not put anything into their mouth.
• After the seizure has finished, turn them on their side to help them breathe more easily.
• Do not give them anything to eat or drink.
• Be calm and reassuring, and stay with them until they have completely recovered.
• Make a note of how long the seizure lasted.

Seeking Medical Help

If you have had a seizure, by law, you must stop driving and notify the relevant authorities and your insurance company. You should also be referred to see a specialist within two weeks. While waiting for the appointment, it's best to avoid any activities that could put you or others in danger if you have another seizure.

Frequently asked questions