Post-stroke seizures: review article
Keywords:epilepsy, stroke, seizures, treatment
There is a tendency towards growing number of strokes in aging population. One of the most significant complications of stroke is post-stroke seizures (PSS), which cause nearly 11 % of all cases of epilepsy. The most important risk factors of seizures after stroke are severity of the stroke, involvement of the cortex and intracerebral hemorrhage. There are two mains forms of PSS — early- and late-onset seizures. The pathogenesis of early-onset seizures is mainly due to cytotoxic and metabolic changes in the ischemic focus in contrast to late-onset seizures, which mostly occur as a result of persistent changes in nervous system excitability. There are following types of seizures in adult patients with post-stroke complications: simple partial, generalized tonic-clonic and generalized seizures. Evaluation of electroencephalography and computed tomography results is an important diagnostic tool of the first line. At the same time, brain magnetic resonance imaging and magnetic resonance angiography are the more preferable methods of neuroimaging due to their more informative grade in detecting cortical malformations, small lesions and cavernomas. Pharmacological management of PSS is traditionally divided into two main categories: prophylactic and symptomatic treatment. Prophylactic antiepileptic treatment in stroke patients, including those with intracerebral haemorrhage to prevent an attack, is not recommended by the American Heart Association and European Stroke Organisation guidelines. Some authors indicate that diuretics, in particular thiazides and furosemide, may be protective, reducing the risk of seizures. Carbamazepine, sodium valproate, lamotrigine, oxcarbazepine or gabapentin are the most used symptomatic drugs recommended as a first-line treatment.
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