Management of Convulsion in Cerebrovascular Accident (Stroke): An Observational Case Series from a Tertiary Care Hospital in India

Abstract

Background: Post-stroke seizures are a clinically important complication of cerebrovascular accident (CVA), reported in 2–15% of survivors depending on stroke subtype, cortical involvement and severity. Optimal antiepileptic strategies remain debated, particularly in hemorrhagic stroke.

Objective: To describe the clinical profile, seizure characteristics and real-world pharmacological management of convulsions among acute stroke patients admitted to a tertiary neurology centre in eastern India.

Methods: A prospective observational case series of 60 consecutive adult patients with acute stroke and clinical or electrographic seizures was conducted at Sparsh Hospital, Bhubaneswar, between April and July 2022. Demographics, comorbidities, stroke type, imaging, daily seizure frequency and antiepileptic drug (AED) regimens were recorded over five hospital days.

Results: Mean age was 62.5 years (range 50–75); 40 patients (66.7%) were female. Hemorrhagic stroke predominated (50/60, 83.3%); ischemic stroke accounted for 10 cases (16.7%). Hypertension was universal; type 2 diabetes was present in 50% and chronic kidney disease in 16.7%. Seizure frequency at admission ranged from 0–8 per day (median 4). Levetiracetam was administered to all patients; phenytoin was added in 40 (66.7%). Seizure control was achieved in every patient by day 3–5. Twenty patients (33.3%) required intubation and sedation. In-hospital mortality during the observation window was 0%.

Conclusion: Prompt initiation of levetiracetam, with phenytoin reserved for more severe or refractory seizures, achieved rapid control of post-stroke convulsions in this cohort. Larger prospective studies are required to define optimal agent selection, dosing and treatment duration, especially in hemorrhagic stroke.