2025
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NEW RENAISSANCE
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE
VOLUME 2
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ISSUE 5
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CLINICAL AND ELECTROENCEPHALOGRAPHIC CHARACTERISTICS OF
VASCULAR EPILEPSY
¹Ne'matullayev Dilmurod
²Raxmonov Muxriddin
³Muxamadiyeva Kamila
¹'²'³1st-year Residents, Department of Neurology,
Samarkand State Medical University
Affiliation: Department of Neurology,
Samarkand State Medical University, Uzbekistan.
https://doi.org/10.5281/zenodo.15511998
Research
Objective
:
To
analyze
the
clinical
manifestations
and
electroencephalographic (EEG) features of vascular epilepsy and assess correlations between
stroke type, lesion location, and seizure characteristics, with the goal of improving early
diagnosis and personalized treatment strategies.
Introduction
: Vascular epilepsy refers to seizure activity that occurs as a consequence
of cerebrovascular disease, especially ischemic or hemorrhagic stroke. This type of epilepsy is
particularly common among elderly patients and is the most frequent cause of seizures in adults
over the age of 60. Despite its prevalence, vascular epilepsy remains underdiagnosed due to
overlapping symptoms with stroke sequelae and insufficient awareness.
The mechanisms of epileptogenesis following stroke are complex, involving neuronal
loss, gliosis, and abnormal synaptic reorganization. Cortical involvement, particularly in the
temporal and frontal lobes, significantly increases the risk of post-stroke epilepsy. Both early-
onset seizures (within 7 days of stroke) and late-onset seizures (after 7 days) may occur, but the
latter are more indicative of chronic epileptogenesis.
Electroencephalography (EEG) serves as a critical diagnostic tool for evaluating
epileptiform activity and localizing foci, though neuroimaging also plays a complementary role.
Vascular epilepsy requires timely differentiation from other post-stroke complications,
as management and prognosis depend heavily on accurate identification.
Materials and Methods
: This descriptive-prospective study was conducted over 18
months at the Neurology Department of Samarkand State Medical University. The study
population included 95 patients diagnosed with epilepsy secondary to ischemic or hemorrhagic
stroke.
2025
MAY
NEW RENAISSANCE
INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE
VOLUME 2
|
ISSUE 5
590
Inclusion criteria
:
1.
History of ischemic or hemorrhagic stroke confirmed by CT or MRI
2.
Diagnosis of epilepsy at least one week post-stroke
3.
Age between 40 and 80 years
4.
Informed consent obtained
Exclusion criteria
:
a.
Pre-existing epilepsy or other seizure disorders
b.
Severe cognitive impairment interfering with EEG interpretation
c.
Severe metabolic disturbances
Assessments and Tools Used
:
1. Detailed neurological examination
2. Review of stroke characteristics (type, location, size)
3. Clinical seizure classification according to ILAE (focal vs. generalized onset)
4. Standard and sleep-deprived EEG
5. Brain imaging (CT/MRI)
6. Modified Rankin Scale (mRS) for functional status
Results
: Among the 95 patients, 63 (66.3%) had ischemic strokes and 32 (33.7%) had
hemorrhagic strokes. Late-onset epilepsy was observed in 76% of the total population, most
frequently 2–12 months post-stroke. The majority of seizures (74%) were focal in onset,
predominantly motor seizures originating from the frontal or temporal lobe.
EEG Findings
:
a.
Epileptiform discharges were recorded in 81% of patients
b.
Temporal lobe spikes/sharp waves in 43% of cases
c.
Frontal slow wave activity and spike-wave discharges in 27%
d.
Multifocal abnormalities in 19% of patients
Correlation Analysis
:
a.
Temporal lobe infarctions showed strong association with complex partial seizures
(p<0.001)
b.
Hemorrhagic strokes were more likely to result in generalized seizures (p=0.017)
c.
Cortical involvement (especially in frontotemporal regions) correlated with higher
frequency and earlier onset of seizures
The functional outcome (mRS) was poorer in patients with recurrent seizures.
2025
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Patients with two or more seizures within the first year had a statistically significant
reduction in quality of life (p<0.01). EEG abnormalities persisted in over half the patients
despite pharmacological control.
Conclusion
: Vascular epilepsy is a common, yet frequently underrecognized
complication of cerebrovascular disease. This study demonstrates that focal seizures, especially
those originating in the temporal and frontal lobes, are predominant in patients with post-stroke
epilepsy. EEG remains a cornerstone in the evaluation of these patients, offering valuable
insight into seizure localization and aiding differential diagnosis.
Temporal lobe infarctions and hemorrhagic lesions are especially epileptogenic, with
late-onset seizures being more indicative of long-term cortical irritability. The presence of
epileptiform activity on EEG correlates well with clinical seizure patterns, allowing for more
accurate diagnosis and monitoring.
Despite the clinical heterogeneity of post-stroke epilepsy, identifying lesion localization
through imaging and EEG can guide the selection of antiseizure medications and inform
prognosis. Patients with cortical involvement, multiple seizures, and persistent EEG
abnormalities require close follow-up and tailored therapeutic strategies.
It is imperative that clinicians integrate cognitive, neurophysiological, and radiological
assessments to diagnose vascular epilepsy early. Proactive management not only reduces
seizure recurrence but also improves rehabilitation outcomes and quality of life. Early EEG
screening and careful monitoring in stroke survivors—especially those with cortical lesions—
should become routine in neurology practice to facilitate timely intervention and prevent
complications.
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