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Stroke is a common cause of acquired epilepsy, and nearly 50% of post-stroke epilepsy (PSE) patients are elderly. Hemorrhage has a higher incidence of post-stroke seizure (PSS) than ischemic stroke, and reports were 7% overall. PSS has different pathophysiology and is classified into early seizure, within seven days, or late seizure, which is beyond seven days after stroke. According to the latest definition, a single late PSS is qualified as structural epilepsy because of a 71.5% high risk of recurrence. Cortical involvement and early seizure are the most important risk factors for subsequent development of PSE, but no evidence supports the use of primary anti-epileptic drug (AED) prophylaxis. Statins used in the acute stage, within three days, can reduce incidence and prevent progression into chronic PSE. Comorbidity and drug-drug interactions should take into account for managing PSE, especially in the elderly population. A particular concern has raised on the increase in thrombotic events when using nonvitamin K antagonist oral anticoagulants and enzyme-inducing AEDs. Further studies on epilepsy connectome and genetic modification on synaptic plasticity, neuronal excitability should gain insight into disease-modifying treatment strategies.