Post-stroke epilepsy: modern aspects of pathogenesis, diagnosis and treatment

Damir A. Enikeyev , Airat R. Galimov , Sofya D. Yakovleva , Yulia L. Markova , Anastasiya K. Pershina , Sofya A. Voznesenskaya , Anasatsiya A. Miticheva , Anastasiya A. Zimina , Kseniya G. Stepanova , Zahar E. Putii , Victoria V. Osipova , Alina Z. Kivorkova , Ruslan I. Minkin , Victoria A. Kalinina

For citation:

Abstract

Acute stroke is the most common cause of seizures and epilepsy in elderly people. Post-stroke epilepsy (PSE) develops in approximately 2–11% of patients who have experienced a stroke, according to various estimates. The article discusses modern aspects of the pathogenesis of PSE, including neurotransmitter imbalance, hormonal dysregulation, blood-brain barrier damage, changes in neural networks, oxidative stress, glial proliferation, and genetic mechanisms. The main prediction methods and possibilities of pharmacotherapy for PSE are also discussed in detail. Despite significant advances in understanding the pathogenesis and treatment of PSE, many questions remain unanswered. There are several promising directions for further research on PSE. The development and reﬁnement of biomarkers of epileptogenesis will allow us to predict which patients may experience seizures after a stroke. This knowledge will also be useful for conducting research on epilepsy therapy. It is extremely important to investigate the impact, tolerability, and interactions of AEDs in patients who have suffered a stroke. It is also necessary to study the interaction of AEDs with oral anticoagulants. Finally, more accurate biomarkers of ongoing epileptic activity are needed to determine which patients may beneﬁt from stopping AEDs. This will optimize treatment and improve the quality of life of patients after a stroke.

Keywords: post-stroke epilepsy, epilepsy, acute cerebrovascular accident, pathogenesis, electroencephalography, antiepileptic drugs.

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For citation: Enikeyev D.A., Galimov A.R., Yakovleva S.D., Markova Yu.L., Pershina A.K., Voznesenskaya S.A., Miticheva A.A., Zimina A.A., Stepanova K.G., Putii Z.E., Osipova V.V., Kivorkova A.Z., Minkin R.I., Kalinina V.A. Post-stroke epilepsy: modern aspects of pathogenesis, diagnosis and treatment. Clinical review for general practice. 2025; 6 (8): 11–17 (In Russ.). DOI: 10.47407/kr2025.6.08.00p4536

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Clinical review for general practice