The prognosis of early seizures after stroke is controversial. We assessed the incidence of late seizures in 31 patients with early seizures complicating acute stroke and compared this with the incidence of late seizures in 31 matched patients with stroke without early seizures. Ten (32%) of 31 patients with early seizures had late seizures during a mean follow-up period of 26 months. Only three (10%) of 31 patients without early seizures had late seizures during the follow-up period of 28 months, a significantly lower incidence than in patients with early seizures. The risk of seizure recurrence in patients with early seizures did not correlate with stroke type or lesion size as imaged on the computed tomographic scan. We conclude that early seizures are not benign and are associated with a significant risk of seizure recurrence.