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Early seizures after ischemic stroke: focus on thrombolysis

Published online by Cambridge University Press:  27 March 2019

Gergely Feher
Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary
Zsuzsanna Gurdan
Department of Paediatric and Adolescent Dentistry, Medical School, University of Pécs, Pécs, Hungary
Katalin Gombos
Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
Katalin Koltai
First Department of Medicine, Medical School, University of Pecs, Pécs, Hungary
Gabriella Pusch
Department of Neurology, Medical School, University of Pecs, Pécs, Hungary
Antal Tibold
Centre for Occupational Medicine, Medical School, University of Pécs, Pécs, Hungary
Laszlo Szapary
Department of Neurology, Medical School, University of Pecs, Pécs, Hungary
E-mail address:



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.

© Cambridge University Press 2019

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

All authors equally contributed to the manuscript including study concept and design, collection of data, analysis and interpretation of data, writing of manuscript, and critical revision of manuscript.


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