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A February ARCHIVES review by Silverman et al¹ addressed stroke-related seizures and epilepsy. We too have been interested in this area of research for more than 15 years and, as part of our effort, wrote an extensive 2-part critical review of the topic.^2-3 Several points that we emphasised in that review were not discussed by Silverman and colleagues, and we would like to address them in this letter.

First, most available studies of poststroke seizures and epilepsy have inherent methodological problems.² Many predate the era of computed tomography and magnetic resonance imaging, do not classify stroke subtype by pathophysiologic characteristics, and do not distinguish between ischemic stroke and intracranial hemorrhage. The design is usually retrospective, using a small sample with high variability. Most critically, the majority of these studies do not differentiate between a single seizure and recurrent seizures (epilepsy). Thus, the incidence and prevalence of poststroke seizures are uncertain.

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