Post-stroke seizures present a global challenge, yet its frequency and factors associated with its incidence are poorly documented, particularly in the Middle East. Thus, this study aims to investigate post-stroke seizure frequency and stroke-associated factors among ischemic stroke patients in Saudi Arabia, addressing demographic, clinical, and comorbid aspects to improve prognosis, diagnosis, prevention, and management. A multicenter, cohort observational study included eligible ischemic stroke patients who were categorized into those who developed seizures after injury and those who did not. Additionally, the study assessed the association between post-stroke seizure and 12-month mortality, 12-month stroke recurrence, and the occurrence of hemorrhagic transformation (HT) within 30 days. The study involved 1235 ischemic stroke patients, in which 13.5% developed post-stroke seizures. Patients with post-stroke seizures had more extended hospital stays, higher intensive care unit (ICU) admission rates, and a higher prevalence of comorbidities. Factors independently associated with post-stroke seizures included previous stroke history (OR = 1.93; 1.35–2.75), ICU admission (OR = 1.7; 1.15–2.5), and depression (OR = 2.1; 1.38–3.30). Logistic regression revealed associations between post-stroke seizures and HT (OR = 2.61; 1.70-4.00), stroke recurrence (OR = 2.30; 1.58–3.36), and mortality (OR = 1.89; 1.33–2.68). However, after adjusting for covariates, post-stroke seizures were significantly associated with stroke recurrence only (aOR = 1.7; 1.11–2.63). Our study identifies notable associations and risk factors for post-stroke seizures in ischemic stroke patients. This underscores the importance of adopting a comprehensive approach to stroke care to enhance the prediction, prevention, and management of post-stroke seizures. Further research is warranted to validate these findings, enhance the understanding of post-stroke seizure mechanisms, and guide management strategies.

Epilepsy is one of the most common neurological disorders affecting people of all ages representing a significant social and public health burden. Current therapeutic options for epilepsy are not effective in a significant proportion of patients suggesting a need for identifying novel targets for the development of more effective therapeutics. There is growing evidence from animal and human studies suggesting a role of impaired brain energy metabolism and mitochondrial dysfunction in the development of epilepsy. Candidate compounds with the potential to target brain energetics have promising future in the management of epilepsy and other related neurological disorders. Creatine is a naturally occurring organic compound that serves as an energy buffer and energy shuttle in tissues, such as brain and skeletal muscle, that exhibit dynamic energy requirements. In this review, applications of creatine supplements in neurological conditions in which mitochondrial dysfunction is a central component in its pathology will be discussed. Currently, limited evidence mainly from preclinical animal studies suggest anticonvulsant properties of creatine; however, the exact mechanism remain to be elucidated. Future work should involve larger clinical trials of creatine used as an add-on therapy, followed by large clinical trials of creatine as monotherapy.

Introduction Short-term use of dual antiplatelet therapy (DAPT) is superior to single antiplatelet therapy (SAPT) for early outcomes in acute ischemic stroke (AIS). However, the long-term effects of SAPT and DAPT remain unclear. This study aimed to evaluate long-term effects of DAPT and SAPT on clinical outcomes in patients with AIS. Methods A retrospective cohort study was conducted at three tertiary hospitals in Saudi Arabia, including 912 patients with AIS who received either DAPT (aspirin plus clopidogrel) or SAPT (aspirin or clopidogrel alone). The primary outcome was the incidence of net adverse clinical and cerebral events (NACCEs), which was defined as the incidence of any hemorrhagic transformation within 30 days, or stroke recurrence and/or all-cause mortality within 12 months of the index stroke. Results Of 4043 screened patients, 912 met the inclusion criteria, with a mean age of 65.47 years. Among them, 582 patients (63.8%) received DAPT. In the treatment selection model, patients with a more severe stroke presentation had lower odds of receiving DAPT. Over the 12-month period, there was no significant difference in the incidence of NACCEs between the DAPT and SAPT groups (p = 0.946). Additionally, the DAPT group showed a higher rate of stroke recurrence within the first 50 days post stroke. In contrast, the SAPT group had higher hemorrhagic transformation and mortality. However, none of these associations were statistically significant (p = 0.1075, 0.0865, and 0.3121, respectively). In the adjusted Cox models, DAPT was not independently associated with stroke recurrence, hemorrhagic transformation, all-cause mortality, or the composite NACCE endpoint (p > 0.05). Conclusion The addition of a second antiplatelet agent did not significantly reduce the long-term risk of stroke recurrence or mortality in patients with AIS over a 12-month period. Further studies are needed to assess long-term benefits and risks of DAPT in different stroke subpopulations.