Mohsen Aghaee
Hakak, MD
Department of
neurology, Epilepsy Center, Razavi Hospital, Mashhad, Iran
Email: Mohsen.hakak@gmail.com
Seizures that occur in close
proximity to an event should be considered as situational or acute symptomatic
or provoked seizures. By definition, provoked seizures are classified as resulting from transient
derangements that involve metabolic, toxic, or medication side-effects, whereas
acute symptomatic seizures are caused by an acute event such as stroke,
traumatic brain injury (TBI), or CNS infection. 40% of all first Seizures (50% to
70% of Status Epilepticus) are acute symptomatic seizures. These seizures
are different from unprovoked seizures both in prognosis and management. In
this review we will discuss about therapeutic approach and risk of recurrence
of acute symptomatic seizures.
In acute phase of brain insult,
patients who experience provoked seizures have higher rate of morbidity and
mortality. In certain conditions due to higher risk of seizure recurrence,
short-term (a few weeks) antiepileptic medications are recommended in acute
period (such as penetrating traumatic brain injuries, subdural hematoma, venous
sinus thrombosis, viral encephalitis and cortical strokes). In patients with
persistent epileptic activity on EEG and structural lesions on imaging longer
treatment is recommended (a few months). In patients who have an unprovoked
seizure subsequently (> week after an event), long-term medication with
antiepileptic drugs should be considered.
Multiple studies have confirmed that
anti-seizure medications may reduce risk of seizure recurrence in the
short-term but it does not appear to alter rate of developing epilepsy in
long-term (In
other words, anti-seizure medication is not anti-epileptogenic).
Keywords: Acute symptomatic seizures, Provoked seizures, Antiepileptic
drugs
