To compare the retention rate and efficacy of different anti-seizure medications (ASM) in post-stroke epilepsy (PSE) patients.

94 patients who were first diagnosed with PSE and initiated ASM monotherapy at Beijing Tiantan Hospital, Capital Medical University from May 2019 to May 2022 were collected retrospectively and followed up for 12 months. Patients were grouped according to the type of ASM they used, and the 1-year drug retention rates of different groups were compared by chi-square test. The efficacy of each ASM was assessed by a standardized monthly seizure frequency and compared through rank-sum test.

In this study, the most commonly used ASMs in PSE patients were levetiracetam (55, 63.95%), sodium valproate (23, 20.93%), and oxcarbazepine (14, 11.63%). In the one-year follow-up, the drug retention rate of levetiracetam was 76.36% (42/55), oxcarbazepine was 71.43% (10/14), and sodium valproate was 43.46% (10/23), the former two had a higher drug retention rate than sodium valproate, and the difference was statistically significant (χ²=7.892, 4.026; P=0.05，0.045). The monthly seizure frequency was 2.0 (0, 4.0) on levetiracetam monotherapy, 1.0 (0, 4.0) on oxcarbazepine monotherapy, and 2.5 (0, 6.0) on sodium valproate, but the differences between groups were not statistically significant (P＞0.05).

Novel ASM such as levetiracetam and oxcarbazepine have higher retention rate in comparison to the conventional ASM sodium valproate in patients with PSE. However, no definitive result has been reached on whether there is a difference in PSE effectiveness among ASM.