The two main reasons for needing a heart transplant are ischemic heart disease and idiopathic cardiomyopathy. Cerebrovascular disease may be much more common in patients with ischemic heart disease than in other transplant patients, and, subsequently, the incidence of cerebral infarct–related seizures may be higher.

During heart transplantation, patients are on bypass pumps for several hours and are vulnerable to significant hypoperfusion and hypoxia.46,47 Grigg et al. reported seizures in 15% of consecutive orthotopic heart transplant recipients.48 All of these patients were treated with cyclosporine. Postoperative focal cerebral ischemic infarctions were noted in two-thirds of patients.48 Ischemic injury experienced during surgery increases the incidence of postoperative seizures.49