Post-stroke epilepsy in Oman: Prevalence, clinical profile, and treatment outcomes

Introduction: Post-stroke epilepsy (PSE), defined as unprovoked seizures occurring more than seven days after stroke onset, is a frequent neurological complication with variable incidence and outcomes. This study estimated the prevalence of PSE among acute stroke patients, described its types, assessed treatment adherence, and outcomes.Method: A retrospective analysis was conducted on acute stroke patients diagnosed with PSE at Sohar Hospital from January 2023 to December 2024.Results: PSE was identified in 7.3% of acute stroke patients. Haemorrhagic stroke accounted for 86.7% of cases, while ischaemic stroke represented 13.3%. Generalised seizures were most common (63.3%), followed by focal seizures (26.7%); 10.0% remained unclassified. All patients were treated with antiseizure medication (ASM) monotherapy—levetiracetam (90%) or carbamazepine (10%). Overall adherence to ASM was 96.7%, with no significant difference between levetiracetam and carbamazepine (p = 0.07). Seizure control was achieved in 90.0% of patients, partial control in 10.0%, and no patients had poor control. Levetiracetam achieved higher control rates than carbamazepine (96.3% vs. 33.3%, p = 0.0006). Gender was not significantly associated with seizure control (p = 0.238).Conclusion: PSE in this study mainly followed haemorrhagic stroke and presented mainly with generalised seizures. Monotherapy with levetiracetam was associated with better seizure control, but due to the small sample size, a larger study is needed to draw firmer conclusions.