Acute symptomatic epileptic seizures and epilepsy after stroke

Abstract

Acute symptomatic epileptic seizures occur within 7 days after the stroke onset. Acute symptomatic epileptic seizures occur in 6.3% of stroke cases: ischemic stroke — 4.2%, cerebral infarction with hemorrhagic transformation — 12.5%, intracerebral hemorrhage — 16.2%. Cumulative risk of subsequent unprovoked epileptic seizure after the first acute symptomatic seizure at follow-up for 10 years is 18.7 %. In acute symptomatic epileptic seizure secondary prevention with antiepileptic drugs usually is not indicated. If antiepileptic drug treatment is initiated after a single acute symptomatic seizure, it should be discontinued after the acute period of the disease. The 10-years risk of subsequent unprovoked epileptic seizures after the single unprovoked epileptic seizure in stroke patients is 71.5%. In this situation the epilepsy diagnosis is reasonable and antiepileptic drug treatment should be initiated. The incidence of epilepsy after acute ischemic or hemorrhagic stroke is identical — 10–12%. The choice of the group of antiepileptic drugs should be based on clinical guidelines for patients with focal forms of epilepsy. Pharmacokinetic interactions between antiepileptic drugs and oral anticoagulants, antiplatelet agents, antihypertensive drugs, and other xenobiotics should be minimized. Thus antiepileptic drugs that induce or inhibit microsomal liver enzymes should also be avoided.

Keywords

acute symptomatic epileptic seizures / antiepileptic drug treatment / cerebral venous thrombosis / epilepsy / stroke / thrombolysis / unprovoked epileptic seizures

References

[1] Beghi E, Carpio A, Forsgren L, et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010;51(4):671–675. DOI: 10.1111/j.1528-1167.2009.02285.x

[2] Beghi E., Carpio A., Forsgren L., et al. Recommendation for a definition of acute symptomatic seizure // Epilepsia. 2010. Vol. 51, No. 4. P. 671–675. DOI: 10.1111/j.1528-1167.2009.02285.x

[3] Bazilevich SN, Odinak MM, Dyskin DE, et al. The structural and functional neurovisualization in patients with epileptic seizures in cerebro-vascular diseases. Zh Nevrol Psikhiatr Im S S Korsakova. 2008;108(Suppl 2):33–39. (In Russ.)

[4] Базилевич С.Н., Одинак М.М., Дыскин Д.Е., и др. Результаты структурной и функциональной нейровизуализации у пациентов с эпилептическими приступами при цереброваскулярных заболеваниях // Журнал неврологии и психиатрии им. С.С. Корсакова. 2008. Т. 108, № S2. С. 33–39.

[5] Beghi E, D’Alessandro R, Beretta S, et al. Incidence and predictors of acute symptomatic seizures after stroke. Neurology. 2011;77(20):1785–1793. DOI: 10.1212/WNL.0b013e3182364878

[6] Beghi E., D’Alessandro R., Beretta S., et al. Incidence and predictors of acute symptomatic seizures after stroke // Neurology. 2011. Vol. 77, No. 20. P. 1785–1793. DOI: 10.1212/WNL.0b013e3182364878

[7] Zöllner JP, Misselwitz B, Kaps M, et al. National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases. Sci Rep. 2020;10(1):3779. DOI: 10.1038/s41598-020-60628-9

[8] Zöllner J.P., Misselwitz B., Kaps M., et al. National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases // Sci. Rep. 2020. Vol. 10, No. 1. P. 3779. DOI: 10.1038/s41598-020-60628-9

[9] Lindgren E, Silvis SM, Hiltunen S, et al. Acute symptomatic seizures in cerebral venous thrombosis. Neurology. 2020;95(12): e1706–e1715. DOI: 10.1212/WNL.0000000000010577

[10] Lindgren E., Silvis S.M., Hiltunen S., et al. Acute symptomatic seizures in cerebral venous thrombosis // Neurology. 2020. Vol. 95, No. 12. P. e1706–e1715. DOI: 10.1212/WNL.0000000000010577

[11] Shamalov NA, Khasanova DR, Stakhovskaya LV, et al. Reperfusion therapy for ischemic stroke. Clinical protocol. Moscow: MEDpress-inform Publishing Hause; 2019. 80 p. (In Russ.)

[12] Шамалов Н.А., Хасанова Д.Р., Стаховская Л.В., и др. Реперфузионная терапия ишемического инсульта. Клинический протокол. М.: МЕДпресс-информ, 2019. 80 с.

[13] Zöllner JP, Misselwitz B, Mauroschat T, et al. Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke. Sci Rep. 2020;10:21083. DOI: 10.1038/s41598-020-78012-y

[14] Zöllner J.P., Misselwitz B., Mauroschat T., et al. Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke // Sci. Rep. 2020. Vol. 10. P. 21083. DOI: 10.1038/s41598-020-78012-y

[15] Hesdorffer DC, Benn EKT, Cascino GD, Hauser WA. Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure. Epilepsia. 2009;50(5):1102–1108. DOI: 10.1111/j.1528-1167.2008.01945.x

[16] Hesdorffer D.C., Benn E.K.T., Cascino G.D., Hauser W.A. Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure // Epilepsia. 2009. Vol. 50, No. 5. P. 1102–1108. DOI: 10.1111/j.1528-1167.2008.01945.x

[17] Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4): 475–482. DOI: 10.1111/epi.12550

[18] Fisher R.S., Acevedo C., Arzimanoglou A., et al. ILAE official report: a practical clinical definition of epilepsy // Epilepsia. 2014. Vol. 55, No. 4. P. 475–482. DOI: 10.1111/epi.12550

[19] Ayvazyan SO, Akzhigitov RG, Alferova VV, et al. Clinical recommendations. Epilepsy and status epilepticus in adults and children. Ministry of Health of the Russian Federation. 2022 Available at: https://sudact.ru/law/klinicheskie-rekomendatsii-epilepsiia-i-epilepticheskii-status-u/ (accessed 10.10.2022). (In Russ.)

[20] Айвазян С.О., Акжигитов Р.Г., Алферова В.В., и др. Клинические рекомендации. Эпилепсия и эпилептический статус у взрослых и детей. Министерство здравоохранения Российской Федерации. 2022 г. Режим доступа: https://sudact.ru/law/klinicheskie-rekomendatsii-epilepsiia-i-epilepticheskii-status-u/ (дата обращения 10.10.2022).

[21] Holtkamp M, Beghi E, Benninger F, et al. European Stroke Organization guidelines for the management of post-stroke seizures and epilepsy. Eur Stroke J. 2017;2(2):103–115. DOI: 10.1177/2396987317705536

[22] Holtkamp M., Beghi E., Benninger F., et al. European Stroke Organization guidelines for the management of post-stroke seizures and epilepsy // Eur. Stroke J. 2017. Vol. 2, No. 2. P. 103–115. DOI: 10.1177/2396987317705536

[23] Gekht A.B. Epidemiology and economic aspects of epilepsy. Zh Nevrol Psikhiatr Im S S Korsakova. 2005;105(8):63–65. (In Russ.)

[24] Гехт А.Б. Эпидемиология и фармакоэкономические аспекты эпилепсии // Журнал неврологии и психиатрии им. С.С. Корсакова. 2005. Т. 105, № 8. С. 63–65.

[25] Galovic M, Ferreira-Atuesta C, Abraira L, et al. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management. Drugs Aging. 2021;38(4):285–299.

[26] Galovic M., Ferreira-Atuesta C., Abraira L., et al. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management // Drugs Aging. 2021. Vol. 38, No. 4. P. 285–299.

[27] Mintzer S, Skidmore CT, Abidin CJ, et al. Effects of antiepileptic drugs on lipids, homocysteine, and C-reactive protein. Ann Neurol. 2009;65(4):448–456. DOI: 10.1002/ana.21615

[28] Mintzer S., Skidmore C.T., Abidin C.J., et al. Effects of antiepileptic drugs on lipids, homocysteine, and C-reactive protein // Ann. Neurol. 2009. Vol. 65, No. 4. P. 448–456. DOI: 10.1002/ana.21615

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