To identify the prevalence of post-stroke seizures (PSS) and role of various anti-seizure drugs (ASDs) in the management of PSS.

Cerebrovascular disease important causes of acquired epilepsy in older adults. It accounts for 11% of all seizures and 55% of newly diagnosed seizures in the elderly.

This is a retrospective study of database from 2015-19. Data was stratified based on demographics, type of stroke, vascular territory, outcomes and role of ASDs in seizure resolution.

There are 2721 patients in database, 180 (6.61%) patients had post-stroke seizures. The mean age was 62.85±18.7 years, the median age of seizure onset was 54.44±21.3 year. Late-onset seizures were more prevalent than early-onset seizures (10.55% vs 89.4%). Ischemic stroke was found in 77.22% of patients, hemorrhagic stroke in 18.88%, and ischemic with hemorrhagic transformation in 3.33%. Approximately 78 % of strokes involved MCA territory vs. 16% in the ACA territory, and 11% in the PCA territory. LVT was used as monotherapy vs polytherapy in 35% vs 23.88% with mean dose 1500 mg/day (500-4000 mg), LTG was used as monotherapy vs polytherapy in 7.77% vs 8.33% with mean dose 279 mg/day (100-800 mg), PHT was used as monotherapy vs polytherapy in 6.11% vs 7.22% with mean dose 500 mg/day (300-900 mg) and LCM was used as monotherapy vs polytherapy in 3.88% vs 12.22% with mean dose of 342 mg/day (100-400 mg). Refractory seizures were found in 46.11% with higher prevalence in hemorrhagic (70.5%) than in ischemic stroke (42.4%) patients (p= 0.0039).

Cerebrovascular disease is a common cause of seizures comprising 6.61% in our epilepsy database. Late­ onset seizures were more common; MCA was the most common arterial involved. Levetiracetam was the most commonly prescribed ASD. Refractory seizures were more prevalent in hemorrhagic stroke although seizure-free rates were low overall in PSS.