After a stroke, are seizures normal?

A fellow caregiver asked...

My healthy, 84 year old father suffered from a non-hemorrhaging stroke 2 years ago caused by afib. He recovered pretty well with just a decreased visual and awareness field remaining. He is on Coumadin. All was fine until seizures began - 3 in 3 months. They bring back all the initial stroke symptoms, weakness on left, speech problems and confusion. A 3 day hospital stay and several weeks of rehab are required each time. I thought seizures last just a few hours. The neurologist is baffled, too. Keppra has been increased several times and is now 1500 mg 2x per day.

Blood pressure is in check and Diabetes is regulated with diet and Metformin. What else should we be looking at?

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Seizures after a stroke are not too uncommon, and can present long after the initial stroke occurred. They are due to scarring of the normal pathways in the brain - I often compare this to an electrical fire in a building with damaged wires. And, at his age, it is not unrealistic to think that the seizures would make him sedated for several days.

The best thing to do in a situation like this is to try and control the seizures with medicines that will not sedate him. In someone his age, one medicine that I particularly like is lamotrigine. It tends to be gentle, with few side effects, if started slowly. You can ask your doctor about that medicine specifically. It could be added to, or replace, the Keppra. At high doses I have found that Keppra can be sedating for someone your father's age.

Also, to be sure nothing else is going on, an EEG, MRI, and MR angiogram could be performed. This should help solidify the diagnosis of seizure, and make sure that other strokes are not occurring.