Post Stroke Seizures Impact on the Course and the Final Outcome of Cerebrovascular Events
Approximately 2% of the patients suffering an acute cerebrovascular event will present with a seizure, mostly of a grand-mal type. Seizures might be present in the acute phase of a stroke, but can as well complicate the long-term course of stroke, in a chronic form. Epileptic fits might quite well have other etiologies (alcoholism, glycemic and electrolyte disorders), thus not necessarily related with the brain ischemia or hemorrhage as the background disorder. Most of the authors define early seizures as occurring within 7-30 days after stroke onset; seizures presenting thereafter are considered as late seizures. Controversial opinions are formulated with regard to the necessity and time length of treatment for early seizures, generally single episodes will be left untreated. On the other hand, authors converge upon the necessity of treating late seizures in the post-stroke setting. Traditional and newly marketed antiepileptics have all of those been tested in different studies; new generation drugs seem advantageous due to their better adverse effect profile and lesser drug interactions.
Seizures, Ischemic Stroke, Hemorrhagic Stroke, Post Stroke Seizures, Prognosis, Disability
Hanson PA, Chodos R. Hemiparetic seizures. Neurology. 1978 Sep; 28(9 Pt 1):920-3.
Binder DK. A history of Todd and his paralysis. Neurosurgery. 2004 Feb; 54(2):480-6; discussion 486-7.
Prabhakaran S, Silver AJ, Warrior L, McClenathan B, Lee VH. Misdiagnosis of transient ischemic attacks in the emergency room. Cerebrovasc Dis. 2008; 26(6):630-5.
Rupprecht S, Schwab M, Fitzek C, Witte OW, Terborg C, Hagemann G. Hemispheric hypoperfusion in postictal paresis mimics early brain ischemia. Epilepsy Res. 2010 May; 89(2-3):355-9.
Masterson K, Vargas MI, Delavelle J. Postictal deficit mimicking stroke: role of perfusion CT. J Neuroradiol. 2009 Mar; 36(1):48-51.
Bråthen G, Brodtkorb E, Sand T, Helde G, Bovim G. Weekday distribution of alcohol consumption in Norway: influence on the occurrence of epileptic seizures and stroke? Eur J Neurol. 2000 Jul; 7(4):413-21.
Berkovic SF, Bladin PF, Darby DG. Metabolic disorders presenting as stroke. Med J Aust. 1984 Mar 31; 140(7):421-4.
Schauwecker PE. The effects of glycemic control on seizures and seizure-induced excitotoxic cell death. BMC Neurosci. 2012 Aug 6; 13:94.
Haddad PM, Dursun SM. Neurological complications of psychiatric drugs: clinical features and management. Hum Psychopharmacol. 2008 Jan; 23 Suppl 1:15-26.
Classen J, Myers SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004; 62:1743–8.
Jordan KG. Continuous EEG monitoring in the neuroscience intensive care unit and emergency department. J Clin Neurophysiol. 1999 Jan; 16(1):14-39.
Zhang C, Wang X, Wang Y, Zhang JG, Hu W, Ge M, Zhang K, Shao X. Risk factors for post-stroke seizures: a systematic review and meta-analysis. Epilepsy Res. 2014 Dec; 108(10):1806-16.
Hamidou B, Aboa-Eboulé C, Durier J, et al. Prognostic value of early epileptic seizures on mortality and functional disability in acute stroke: the Dijon Stroke Registry (1985-2010). J Neurol 2013; 260:1043–1051.
Huang CW, Saposnik G, Fang J, Steven DA, Burneo JG. Influence of seizures on stroke outcomes: a large multicenter study. Neurology. 2014 Mar 4; 82(9):768-76.
Goswami RP, Karmakar PS, Ghosh A. Early seizures in first-ever acute stroke patients in India: incidence, predictive factors and impact on early outcome. Eur J Neurol. 2012 Oct; 19(10):1361-6.
Procaccianti G, Zaniboni A, Rondelli F, Crisci M, Sacquegna T. Seizures in acute stroke: incidence, risk factors and prognosis. Neuroepidemiology. 2012; 39(1):45-50.
Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Coté R, Lebrun L, Pirisi A, Norris JW. Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000 Nov; 57(11):1617-22.
Kessler KR, Schnitzler A, Classen J, Benecke R. Reduced inhibition within primary motor cortex in patients with poststroke focal motor seizures. Neurology. 2002 Oct 8; 59(7):1028-33.
Claassen J, Jetté N, Chum F, Green R, Schmidt M, Choi H, Jirsch J, Frontera JA, Connolly ES, Emerson RG, Mayer SA, Hirsch LJ. Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology. 2007 Sep 25; 69(13):1356-65.
Silverman IE, Restrepo L, Mathews GC. Poststroke seizures. Arch Neurol. 2002 Feb; 59(2):195-201.
Conrad J, Pawlowski M, Dogan M, Kovac S, Ritter MA, Evers S. Seizures after cerebrovascular events: risk factors and clinical features. Seizure. 2013 May; 22(4):275-82.
Preçi G, Vyshka G. Alcohol Abuse and Seizures: an Overview of Clinical Notions and Pathogenetic Theories. International Journal of Clinical and Experimental Neurology. 2014; 2(1):4-7.
Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. BMJ. 1997 Dec 13; 315(7122):1582-7.
Misra UK, Kalita J. Management of provoked seizure. Ann Indian Acad Neurol. 2011 Jan; 14(1):2-8.
Goldstein LB, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol. 1989; 46:660- 662.
De Haan R, Horn J, Limburg M, Van Der Meulen J, Bossuyt P. A comparison of five stroke scales with measures of disability, handicap, and quality of life. Stroke. 1993 Aug; 24(8):1178-81.
Cote R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C. The Canadian Neurological Scale: a preliminary study in acute stroke. Stroke. 1986; 17:731-737.
Schwab S, Krieger D, Müllges W, Hamann G, Hacke W. Neurologische Intensivmedizin. Springer-Verlag Berlin Heidelberg. 1999; 351.
Chung JM. Seizures in the acute stroke setting. Neurological Research. 2014; 36(5): 403-406.
Naidech AM, Kreiter KT, Janjua N, Ostapkovich N, Parra A, Commichau C, Connolly ES, Mayer SA, Fitzsimmons BF. Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke. 2005 Mar; 36(3):583-7.
Panayiotopoulos CP. The Epilepsies. Seizures, Syndromes and Management. Bladon Medical Publishing, UK. 2005; 22-23.