Seizures can be a clinical presentation of acute stroke or complicate the clinical course of patients with stroke. Post-stroke seizures are significantly more common in patients with cortical involvement, severe and large size stroke and those with cortical hemorrhagic transformation of ischemic stroke. The influence of post-stroke seizures on functional outcome is controversial. The differences concerning the pathophysiology of and recurrence risk for early and late seizures suggests the need for a specific management. The choice of the antiepileptic drug will be influenced by the risk of drug interactions and possible side effects, especially in the elderly. Currently there is no evidence to support the use of antiepileptic drugs in patients with stroke in the absence of seizure even in the presence of risk factors for developing seizure.