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Post-stroke epilepsy — SCE Neurology MCQ

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HardEpilepsyPost-stroke epilepsySCE Neurology

A patient has recurrent unprovoked focal-to-bilateral seizures beginning after a remote cortical infarct. What long-term management principle is appropriate?

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Correct answer: DOffer long-term antiseizure treatment for structural focal epilepsy

The best answer is “Offer long-term antiseizure treatment for structural focal epilepsy”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Treat each recurrence acutely without preventive therapy”, “Use dual antiplatelet therapy as chronic seizure prevention”, “Start anticoagulation because the remote infarct involved cortex”, “Stop antiseizure treatment after the first seizure-free month” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/