ReviewLate-onset seizures and risk of subsequent stroke: A systematic review

•Cerebrovascular disease often underlies otherwise unexplained late-onset seizures.•Patients presenting with late-onset seizures are at increased risk of stroke.•These patients should be screened for the presence of vascular risk factors.

Otherwise unexplained late-onset seizures, conventionally defined as epileptic seizures occurring in subjects older than 60 years and in the absence of disorders known to increase the risk of developing epilepsy, have been assumed to be, in most cases, of cerebrovascular origin. We systematically searched the literature to identify the evidence supporting the association between otherwise unexplained late-onset seizures/epilepsy and the risk of subsequent stroke. Most data from the literature indicate that cerebrovascular disease often underlies otherwise unexplained late-onset seizures/epilepsy. Patients presenting with seizures occurring for the very first time in late life and without clinically overt cerebrovascular disease should be considered as at increased risk of stroke. Consequently, these patients should be screened for the presence of vascular risk factors and treated accordingly. Such measures may greatly contribute to prevent strokes in these patients.