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Hypertension, seizures, and epilepsy: a review on pathophysiology and management

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Abstract

Background

Epilepsy and hypertension are common chronic conditions, both showing high prevalence in older age groups. This review outlines current experimental and clinical evidence on both direct and indirect role of hypertension in epileptogenesis and discusses the principles of drug treatment in patients with hypertension and epilepsy.

Methods

We selected English-written articles on epilepsy, hypertension, stroke, and cerebrovascular disease until December, 2018.

Results

Renin-angiotensin system might play a central role in the direct interaction between hypertension and epilepsy, but other mechanisms may be contemplated. Large-artery stroke, small vessel disease and posterior reversible leukoencephalopathy syndrome are hypertension-related brain lesions able to determine epilepsy by indirect mechanisms. The role of hypertension as an independent risk factor for post-stroke epilepsy has not been demonstrated. The role of hypertension-related small vessel disease in adult-onset epilepsy has been demonstrated. Posterior reversible encephalopathy syndrome is an acute condition, often caused by a hypertensive crisis, associated with the occurrence of acute symptomatic seizures. Chronic antiepileptic treatment should consider the risk of drug-drug interactions with antihypertensives.

Conclusions

Current evidence from preclinical and clinical studies supports the vision that hypertension may be a cause of seizures and epilepsy through direct or indirect mechanisms. In both post-stroke epilepsy and small vessel disease-associated epilepsy, chronic antiepileptic treatment is recommended. In posterior reversible encephalopathy syndrome blood pressure must be rapidly lowered and prompt antiepileptic treatment should be initiated.

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Acknowledgments

We thank the members of the Epilepsy Study Group of the Italian Neurological Society: Abate Francesca, Aloisi Paolo, Arcudi Luciano, Bogliun Graziella, Buttinelli Carla, Campostrini Roberto, Coppola Antonietta, Costanzo Erminio, De Maria Giovanni, Elia Maurizio, Ferrigno Giulia, Franceschetti Silvana, Galimberti Carlo Andrea, Garcea Teresa, Giallonardo Anna Teresa, Iannacchero Rosario, La Neve Angela, Latella Maria Adele, Le Piane Emilio, Magaudda Adriana, Maschio Marta, Mastroianni Giovanni, Mecarelli Oriano, Minicucci Fabio, Mumoli Laura, Musolino Rosa, Paciello Nicola, Paladin Francesco, Pisani Francesco, Polidoro Serena, Rocchi Raffaele, Silvestri Rosalia, Sofia Vito, Specchio Luigi M., Striano Salvatore, Tinuper Paolo, and Zaccara Gaetano.

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Correspondence to Umberto Aguglia.

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Gasparini, S., Ferlazzo, E., Sueri, C. et al. Hypertension, seizures, and epilepsy: a review on pathophysiology and management. Neurol Sci 40, 1775–1783 (2019). https://doi.org/10.1007/s10072-019-03913-4

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