Medical records of patients diagnosed with vascular epilepsy were included. Specifically, the study included patients who experienced unprovoked epileptic seizures occurring or persisting for more than 7 days after a stroke.

Exclusioncriteria: patients with acute symptomatic seizures (seizures occurring within the first 7 days following a stroke and not persisting beyond 7 days) and those whose incomplete medical records did not allow for a definitive diagnosis of vascular epilepsy.

Seizureremission: defined as the complete absence of seizures based on medical record data (date of the last seizure).Treatmentefficacy: defined as a reduction in seizure frequency of more than 50% maintained for more than 6 months.

Data were collected using KoboToolbox via its KoboCollect application. Quantitative data (age) were expressed as means and standard deviations, while qualitative data (occupation, seizure type, stroke type, type of antiepileptic treatment, adverse effects, treatment efficacy, seizure remission, seizure-free duration, and reasons for persistent seizures) were expressed as frequencies and percentages. Data were collected after obtaining verbal consent from patients or a family member, ensuring absolute anonymity and confidentiality.

The most commonly used treatments in our study were levetiracetam, sodium valproate, carbamazepine, and phenobarbital, at 28.3%, 16.98%, 15.09%, and 13.21%, respectively. This distribution of antiepileptic drugs reflected a therapeutic transition in West Africa, balancing the rise of newer-generation medications with the continued use of older treatments.

Indeed, the predominance of levetiracetam was consistent with the results of studies conducted in Senegal and Nigeria [4][5], which had highlighted a growing adoption of newer medications in urban areas of West Africa among the elderly and patients with vascular diseases. Levetiracetam’s lack of enzyme induction prevents any interaction with antithrombotic and antihypertensive agents. However, its clinical use requires caution; in our series, observed adverse effects included drowsiness in 7.55% of patients and psychiatric disorders in 3.77%. Neuropsychiatric disorders were also reported in the West African cohort by Ogunjimi et al. as well as in the international SANAD II trial [6].

Sodium valproate has retained an important role due to its broad-spectrum efficacy, but regional data from West Africa and the EURAP registry [7] have highlighted its metabolic and teratogenic limitations in women, as well as the risks of bleeding interactions with post-stroke antiplatelet agents.

As for carbamazepine and phenobarbital, their frequent use in our series reflected prescribing practices in West Africa [4][5]. In Benin, the study by Adoukonou et al. on the follow-up of stroke patients showed that, while carbamazepine is effective for focal seizures of vascular origin, its cost and interactions with cytochromes complicate the management of cardiovascular comorbidities. For its part, phenobarbital—promoted by the WHO’s mhGAP program in sub-Saharan Africa—ensures immediate affordability but exacerbates sedation and cognitive decline in patients with cerebrovascular diseases.

In terms of long-term outcomes, the overall response rate of 60.38% and prolonged remission (>24 months) in 36.36% of patients (n = 12) were comparable to the rates of post-stroke seizure control reported in clinical series in sub-Saharan Africa [4]. Nevertheless, reasons for persistent seizures included poor adherence (18.87%, n = 10), loss to follow-up (7.54%, n = 4), financial cost (3.77%, n = 2), anxiety (1.89%, n = 1), and underdosing (1.89%, n = 1). These factors contributing to treatment failure echo the findings of Adoukonou et al. in Benin and Ogunjimi et al. in Nigeria, who identified financial barriers, the lack of long-term follow-up, and the lack of therapeutic education as the main causes of the subregional treatment “gap” [3][5].

Finally, the study by Jost et al. [8] on the quality of antiepileptic drugs in West Africa (Togo) highlighted that thermal degradation and the instability of generic drugs in tropical climates constitute an additional factor explaining the persistence of seizures, regardless of patient adherence.

This local clinical experience thus reflects the realities of West Africa, where the safety of modern medications is pitted against socioeconomic barriers to adherence to conventional treatments.