Scientific article
Open access

Acute symptomatic seizures and hippocampal sclerosis: the major contributor for post-stroke epilepsy ?

Published inJournal of neurology, vol. 269, no. 11, p. 5934-5939
Publication date2022-07-07
First online date2022-07-07


Hippocampal sclerosis (HS) is a prominent biomarker of epilepsy. If acquired later in life, it usually occurs in the context of degenerative or acute inflammatory-infectious disease. Conversely, acute symptomatic seizures (ASS) are considered a risk factor for developing post-stroke epilepsy, but other factors remain unrecognized. Here, we hypothesize that silent hippocampal injury contributes to the development of post-stroke epilepsy.


We performed a retrospective observational study of patients hospitalized between 1/2007 and 12/2018 with an acute stroke in the Stroke Center of the Geneva University Hospital. Patients were included if they had a documented normal hippocampal complex at onset and a control MRI at ≥ 2 year interval without new lesion in the meantime.


162 patients fulfilled our inclusion criteria. ASS during the first week ( p < 0.0001) and epileptiform abnormalities in electroencephalography (EEG; p = 0.02) were more frequently associated with the development of epilepsy. Hemorrhagic stroke was strongly associated to both ASS and future focal epilepsy ( p = 0.00097). Three patients (1.8%) developed hippocampal sclerosis ipsilateral to the cerebrovascular event between 2 and 5 years, all with ASS and hemorrhagic stroke.


ASS and epileptiform EEG abnormalities are strong predictors of post-stroke epilepsy. HS develops in a minority of patients after hemorrhagic lesions, leading to focal epilepsy. Prospective studies are required, including follow-up with EEG and if characterized by epileptiform discharges, with MRI, to determine the true frequency of HS and to better understand predictors of post-stroke epilepsy (AAS, stroke type, and HS), and their impact on stroke recovery.

  • Acute symptomatic seizures
  • EEG
  • Elderly
  • Geriatric
  • Hemorrhagic
  • Hippocampal sclerosis
  • Interictal epileptiform discharges
  • Ischemic
  • Post-stroke epilepsy
  • Provoked seizures
  • Spikes
  • Stroke
Citation (ISO format)
STANCU, Patrick et al. Acute symptomatic seizures and hippocampal sclerosis: the major contributor for post-stroke epilepsy ? In: Journal of neurology, 2022, vol. 269, n° 11, p. 5934–5939. doi: 10.1007/s00415-022-11254-0
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Article (Published version)
ISSN of the journal0340-5354

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