Post-stroke epilepsy: predisposing factors and pathophysiology – a review
Mel R. de Melo, Afya Faculdade de Ciências Médicas de Itabuna, Bahia, Brasil
Rhuan da S. Santos, Afya Faculdade de Ciências Médicas de Itabuna, Bahia, Brasil
Alexandre A. Carvalho, Afya Faculdade de Ciências Médicas de Itabuna, Bahia, Brasil
Geovanna dos S. Pereira, Afya Faculdade de Ciências Médicas de Itabuna, Bahia, Brasil
Isabela de F. Maia, Afya Faculdade de Ciências Médicas de Itabuna, Bahia, Brasil
Nathália S. Barboza, Centro Universitário de Excelência, Unex, Itabuna, Bahia, Brasil
Luciana T. R. Souza, Afya Faculdade de Ciências Médicas de Itabuna, Bahia, Brasil
Nathan S. Barboza, Afya Faculdade de Ciências Médicas de Itabuna, Bahia, Brasil
Post-stroke epilepsy (PSE) is one of the most frequent and clinically relevant complications of stroke, significantly contributing to morbidity, functional decline, and reduced quality of life. Seizures may occur early after stroke or manifest later as epilepsy, reflecting distinct underlying mechanisms. This integrative review aims to synthesize current evidence on the incidence, predisposing factors, and pathophysiological mechanisms associated with PSE following ischemic and hemorrhagic stroke (HS). A literature search was conducted in PubMed and SciELO, including studies published between 2019 and 2024. Evidence indicates that HS, cortical involvement, greater stroke severity, and early post-stroke seizures are consistently associated with an increased risk of developing PSE. Emerging data highlight epileptogenesis as a dynamic process driven by structural brain injury, neuroinflammation, blood–brain barrier disruption, and maladaptive neuronal reorganization, which together promote persistent neuronal hyperexcitability. However, considerable heterogeneity in study design, outcome definitions, and follow-up duration limits direct quantitative comparisons across studies. Overall, the findings underscore the multifactorial nature of PSE and emphasize the need for standardized methodologies and prospective studies to improve risk stratification and guide the development of targeted preventive strategies.
