# Pharmacological strategies for preventing post-stroke seizures and epilepsy

## TL;DR

This paper reviews strategies for preventing seizures and epilepsy after stroke, focusing on potential pharmacological treatments and the need for further research.

## Contribution

The paper highlights levetiracetam and lamotrigine as potential agents for preventing seizures and identifies under-researched drugs needing further study.

## Key findings

- Levetiracetam and lamotrigine may be preferred for preventing acute seizure recurrence.
- Statins, GLP-1 agonists, and other drugs need further study for seizure prevention in stroke patients.
- Biomarker research could improve clinical trials for antiseizure medications.

## Abstract

Stroke is the most common cause of new-onset seizures and epilepsy in the older population, which is associated with increased morbidity and mortality. Post-stroke seizures (PSS) are traditionally divided into early and late seizures, occurring before and after 7 days post-stroke, respectively. A single late seizure is sufficient to diagnose post-stroke epilepsy. This narrative review discusses approaches to diagnosing and treating PSS, as well as the various pharmacological agents available. Although current evidence is limited, we suggest that levetiracetam and lamotrigine may be preferred agents for preventing acute seizure recurrence. Statins, GLP-1 agonists, eslicarbazepine, perampanel, and losartan have not been evaluated yet and need further study on their ability to prevent first-time seizures in stroke patients. While clinical trials of antiseizure medications can be costly, further research into biomarkers of epileptogenesis could facilitate more feasible clinical trials to enhance the evidence base for antiseizure medications in post-stroke seizures and epilepsy.