Stroke is a significant underlying cause of epilepsy. Seizures due to ischemic stroke
(IS) are generally categorized into early seizures (ESs) and late seizures (LSs).
Seizures in thrombolysis situations may raise the possibility of other etiology than
IS.We overtook a systematic review focusing on the pathogenesis, prevalence, risk
factors, detection, management, and clinical outcome of ESs in IS and in stroke/thrombolysis
situations. We also collected articles focusing on the association of recombinant
tissue-type plasminogen activator (rt-PA) treatment and epileptic seizures.We have
identified 37 studies with 36,775 participants. ES rate was 3.8% overall in patients
with IS with geographical differences. Cortical involvement, severe stroke, hemorrhagic
transformation, age (<65 years), large lesion, and atrial fibrillation were the most
important risk factors. Sixty-one percent of ESs were partial and 39% were general.
Status epilepticus (SE) occurred in 16.3%. 73.6% had an onset within 24 h and 40%
may present at the onset of stroke syndrome. Based on EEG findings seizure-like activity
could be detected only in approximately 18% of ES patients. MRI diffusion-weighted
imaging and multimodal brain imaging may help in the differentiation of ischemia vs.
seizure. There are no specific recommendations with regard to the treatment of ES.ESs
are rare complications of acute stroke with substantial burden. A significant proportion
can be presented at the onset of stroke requiring an extensive diagnostic workup.