Discussion In older adults, stroke is the most common cause of epileptic seizures; epilepsy is also the most common sequela of stroke. One study showed that 8.6% of patients with ischemic stroke and 10.6% of patients with hemorrhagic stroke develop epileptic seizures. Post-stroke epileptic seizures can be divided into two main categories based on the time of presentation (although there is disagreement, most study groups define them as follows): early epileptic seizures occur within 2 weeks of stroke onset; late epileptic seizures occur 2 weeks after stroke onset. More than half of the stroke-associated epileptic seizures were of early onset. The study described earlier showed that 56% of ischemic stroke patients with epileptic seizures were early-onset and 44% were late-onset; 75% of hemorrhagic stroke patients with epileptic seizures were early-onset and only 25% were late-onset. The earliest epileptic seizures can occur within 24 hours of stroke onset. The incidence of post-stroke epileptic seizures also increases with increasing cortical localization and hemorrhage volume. The CAVE score has been established to stratify the risk of late epileptic seizures in patients after intracranial hemorrhage, based on the following criteria: cortical localization (1 point), age <65 years (1 point), bleeding volume >10 ml (1 point), and presence of early epileptic seizures (1 point). The risk of developing a late epileptic seizure was approximately 0.6% (0 points), 3.6% (1 point), 9.8% (2 points), 34.8% (3 points), and 46.2% (4 points), respectively. The proportion of post-stroke seizures or epileptic seizure recurrences was highly variable; however, those with delayed epileptic seizures were more likely to have seizures or recurrences than those with early seizures. In patients with ischemic or hemorrhagic stroke, epilepsy occurs in approximately 30% of patients with early-onset epileptic seizures and 90% of patients with late-onset epileptic seizures. Patients with early-onset epileptic seizures are also more likely to have epilepsy than patients with general stroke. Interestingly, among general stroke patients, patients with hemorrhagic stroke (10-15%) were more likely to have epilepsy than patients with ischemic stroke (6-9%). For patients with delayed epileptic seizures are more likely to develop epilepsy, probably because of the different pathophysiological mechanisms between delayed and early episodes. Early-onset epileptic seizures may be secondary to focal metabolic disturbances and excitotoxic neurotransmitter production; such metabolic disturbances are self-limiting, whereas late-onset epileptic seizures may be due to glial cell proliferation and intracerebral scar formation in the meninges, which are persistent. Management of post-stroke epileptic seizures There are no specific guideline opinions and indeed little evidence on the timing and drug selection for antiepileptic drug therapy for post-stroke epileptic seizures. However, there is consensus that the decision to administer antiepileptic medication should depend on the likelihood of recurrent epileptic seizures. Most patients with early-onset epileptic seizures do not progress to epilepsy and therefore do not require long-term drug therapy. Many neurologists agree that multiple episodes of early-onset epileptic seizures or persistent status should be treated with antiepileptic drugs for ≥3 months; however, it is controversial whether a single early-onset seizure should be treated. One approach is to treat patients with a single early-onset epileptic seizure first with antiepileptic medication, and then discontinue the medication if there are no epileptic discharges when discharged from the hospital with an EEG assessment. Such patients are unlikely to have a recurrence of epileptic seizures. Patients with delayed-onset epileptic seizures have a much higher chance of having a recurrence (90%) and generally require lifelong antiepileptic drug therapy. Adverse effects and drug interactions should be noted when using antiepileptic drugs.