A stroke sometimes causes seizures, either soon after the stroke or some time later. This can have a big impact on you and your recovery. It might feel like a lot to deal with on top of having a stroke, but your medical team should ensure you get any treatment you may need.

If you have a seizure after a stroke, it does not necessarily mean you have epilepsy or will go on to develop it. This page has more information on types of seizure, diagnosing epilepsy and treatment.

On this page menu

• What is a seizure?
• What is epilepsy?
• Types of seizure
• Diagnosing epilepsy
• Epilepsy treatments
• Complications of epilepsy
• First aid for seizures
• Resources

What is a seizure?

A seizure is a sudden, abnormal burst of electrical activity in your brain. It happens when the electrical signals between brain cells get disrupted. This sends abnormal signals to the nerves in your body, causing a seizure.

A stroke can trigger this burst of electrical activity by damaging the connections between some of your brain cells. A seizure is most likely to happen within the first few days after a stroke but can also happen months or years later.

You are more likely to have a seizure if you had a severe stroke, 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.

Estimates vary but it’s thought about 1 in 10 people have a seizure after a stroke. Your medical team will be aware of the risk soon after a stroke and will make sure you get any treatment you need. Overall, your risk of having a seizure goes down over time.

If you have a seizure soon after a stroke, it does not necessarily mean you have epilepsy or will go on to develop it. However, if a seizure happens weeks, months or years after your stroke, or you have more than one seizure, you may be diagnosed with epilepsy as the risk of further seizures may be higher.

What is epilepsy?

Epilepsy is a condition that affects your brain and means a tendency to have repeated seizures. People can develop epilepsy at any age.

Epilepsy can be due to a stroke, another brain injury or other conditions such as an infection or a tumour in the brain.

In about half of all cases, there is no known cause. In people aged over 60, cerebrovascular diseases such as stroke are thought to be the most common cause of new cases of epilepsy. But most people who have a stroke will not develop epilepsy.

Types of seizure

Seizures can vary, with symptoms ranging from tingling sensations to shaking and losing consciousness. Some people have only one type of seizure, and some have more than one type.

The main types of seizure include:

Focal seizures

Some seizures only occur in part of the brain, known as focal seizures. These seizures may have different symptoms, depending on where they start in the brain. Symptoms may include unusual feelings, sensations or movements, such as a ‘rising’ feeling in your stomach, tingling or twitching in part of your body. In some types of focal seizure, your awareness and responsiveness to what’s happening around you may be affected. You may have unusual behaviours, like smacking your lips or picking at your clothing.

After it begins, a focal seizure can sometimes spread to both sides of the brain and become a generalised seizure.

Generalised seizures

A generalised seizure involves the whole brain and affects the whole body. There are different types with different symptoms. Physical signs can include losing consciousness, falling over and muscle spasms with jerking or shaking. You may bite your tongue or wet yourself.

What happens after a seizure?

After a seizure ends, some people may feel fine quite quickly, but for most others, it may take hours or sometimes days to feel ‘normal’ again. The period after a seizure is sometimes called the post-ictal phase. You may feel very tired, confused, have a headache or want to sleep. Talk to people close to you about how they can support you if you experience this. If you have any concerns about symptoms after a seizure, speak to your doctor.

• Epilepsy Action has more information on different types of seizure.
  
  

Diagnosing epilepsy

A specialist will ask you what happened when you had a seizure. You may also need to have brain imaging, blood tests or a test to measure electrical activity in the brain.

If you think you may have had a seizure and did not get medical help at the time, contact your GP for an urgent appointment. You should be referred to see a specialist within two weeks. The specialist is usually a neurologist, an expert in the brain and nervous system.

While you are waiting for the appointment, it’s best to avoid any activities that could put you, or others, in danger if you have another seizure. For example, do not go swimming, have showers rather than baths and avoid activities at height, like climbing ladders. You must not drive if you have had a seizure or suspected seizure.

You may not be able to remember the seizure, so if someone else saw it, they should attend your appointment with your specialist with you. They could write down what happened or share a video of the seizure if they have one.

Keep a seizure diary recording the date and time of your seizures, what happened and any possible triggers, such as stress or lack of sleep. At your appointment, the specialist will ask you questions about what happened. This may be enough to make a diagnosis.

Further tests may be needed. Although these tests do not necessarily prove whether you have epilepsy, they can give information about the possible cause, and the type of epilepsy you have.

Tests used in diagnosing epilepsy

Electroencephalogram (EEG)

A common test for epilepsy is an EEG. An EEG usually takes about one hour and can be done at an outpatient clinic. It’s a painless test which involves placing sticky patches called electrodes on your scalp. These measure electrical activity in your brain and can identify any unusual patterns. The test only shows what is happening in your brain at the time it is done, so a normal EEG does not necessarily mean that you do not have epilepsy.

Electrocardiogram (ECG)

An ECG records the electrical activity of the heart. It can be used to check if your symptoms may have been caused by a heart condition. It’s a painless test which involves sticking electrodes to your arms, legs and chest.

Magnetic resonance imaging (MRI) scan

An MRI scan can find problems inside the brain which might cause epilepsy, including the damage left by a stroke.

Blood tests and other checks

You may be given blood tests or other checks to look for health problems that can cause similar symptoms, such as diabetes, migraine and panic attacks.

Epilepsy treatments

Treatments include:

Medication

Anti-seizure medication (ASM), also known as anti-epileptic drugs (AEDs), can often reduce or stop seizures. It’s the most common treatment for post-stroke epilepsy. The treatment you have will depend on:

• What type of seizures you have.
• Your age and sex.
• How frequent your attacks are.
• Other effects of your stroke, like swallowing problems.
• Other medication you are taking.

The medication works by changing the levels of chemicals in the brain. It cannot cure epilepsy, but can help prevent seizures effectively and help you get on with everyday life.

Your doctor might start you on a low dose and increase it gradually to find the dose that works for you.

The medication can sometimes have side effects in some people, such as drowsiness, dizziness and confusion. Everyone is different, and some people do not get any side effects at all. If you do have side effects, speak to your doctor as you may be able to try a different type or combination of medications.

If you take anti-seizure medication, this and all other NHS prescriptions are free of charge. In England, you may need to get an exemption certificate.

Surgery

Very occasionally, surgery may be an option if medication does not help you, and if your epilepsy is due to certain causes in your brain, such as scarring or stroke damage. Whether you can have surgery depends partly on where the problem lies inside your brain, and whether a surgeon can reach it safely. You will need to explore the possible benefits and risks with your doctor before choosing to go ahead.

Vagus nerve stimulation therapy

This treatment may be an option if medications do not help you and you’re not suitable for surgery. It aims to reduce seizures and seizure severity. It works by stimulating the vagus nerve, which travels from your brain and reaches several parts of your body, including your heart and lungs. A small device is implanted in your chest which connects with a wire on the vagus nerve in the neck. It sends regular electric signals via the vagus nerve to the brain to try and regulate electrical activity in the brain.

Ketogenic diet

This treatment is used for children (and occasionally adults) who do not respond to anti-seizure medication, and involves a high-fat, low-carbohydrate diet. It's thought this changes the way the brain uses energy, which may reduce seizures. It should only be used with the help of a specialist doctor and dietitian.

Complications of epilepsy

Sudden death in epilepsy (SUDEP)

SUDEP can lead to someone dying unexpectedly during an epileptic seizure, often in their sleep. SUDEP is rare, affecting about one in 1,000 adults with epilepsy a year. Taking anti-seizure medication as prescribed can reduce or prevent seizures, and reduce the chance of SUDEP. Support and information are available from SUDEP Action.

Status epilepticus

Status epilepticusis a serious complication of epilepsy. It means someone has a seizure which lasts a long time (over five minutes) or has repeated seizures without recovering in between. It is a medical emergency and you need to get help straight away.

First aid for seizures

If you are looking after someone having an epileptic 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 round.
• 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 in the recovery position to help them breathe more easily.
• Do not give them anything to eat or drink.
• Be calm and reassuring. Stay with them until they have completely recovered.
• Make a note of the time the seizure happened and how long it lasted.
• The Epilepsy Society has more information on first aid for different types of seizures.

Call 999 if any of these things happen:

• You think it is the person’s first seizure.
• One seizure follows another without the person recovering in between.
• The seizure lasts for longer than is usual for them, or longer than five minutes if you do not know how long their seizures usually last.
• The person is injured, does not regain consciousness, has breathing problems after the seizure, or seems to need urgent medical attention.
• They’ve now had three or more seizures in the last 24 hours.

Resources

The information on this page can also be accessed in the following formats:

• Download this information as a
  • PDF
  • Word document
• Order a printed copy from our shop.
• To request a braille copy, email helpline@stroke.org.uk.