To determine the incidence of epilepsy and frequency of EEG testing in US Veterans within 10 years of acute stroke, and to characterize EEG findings in Veterans post-stroke.

Epilepsy is a common complication of stroke in the civilian population and is associated with increased morbidity and mortality. This relationship has not been well-investigated in US Veterans, whose unique set of exposures and comorbidities may influence outcomes after stroke.

This is a retrospective cohort study including chart reviews of all US Veterans admitted to a single-center VA hospital with acute stroke between 1/1/2012 – 7/1/2012, to determine incidence of seizures, EEG evaluation, anti-seizure medication (ASM) prescriptions, and mortality over 10 years post-stroke.

Of the 56 unique Veterans admitted for stroke, 12 (21.4%) underwent EEG testing within 10 years of stroke. Of these, 7/12 (58.3%) had abnormal EEGs including: 5 (41.7%) with diffuse slowing, 5 (41.7%) with focal slowing, 2 (16.7%) with epileptiform discharges, and 1 (8.3%) in status epilepticus upon initial EEG testing. At study endpoint, four (7.1%) of the included Veterans had newly been started on ASMs for presumed post-stroke epilepsy. Latency from time of stroke to seizure onset was 9, 21, 78, and 111 months. At the time of stroke, four (7.1%) of Veterans had pre-existing epilepsy or significant concern for prior seizures; none of these had subsequent EEGs or new ASMs prescribed within 10 years post-stroke. As of 9/1/2023, 41 (73.2%) of the cohort were deceased; 25 (61%) of whom died within 5 years of stroke, and 100% of the patients diagnosed with post-stroke epilepsy.

In this small cohort of Veterans with stroke, 7.1% developed new-onset epilepsy within 10 years following stroke. 7.1% of these patients had pre-existing epilepsy or seizures at the time of stroke, but none of these Veterans experienced worsening of their seizure control post-stroke.