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Acute Symptomatic Seizures and Provoked Seizures: to Treat or Not to Treat?

  • Epilepsy (E Waterhouse, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

Acute symptomatic and provoked seizures by definition occur in close proximity to an event and are considered to be situational. The treatment implications and likelihood of recurrence of acute symptomatic and provoked seizures differ from unprovoked seizures. In this article, the authors review the literature on acute symptomatic and provoked seizures with regard to therapeutic approach and risk of recurrence.

Recent findings

In the acute period, patients who suffer from acute symptomatic and provoked seizures have higher rates of morbidity and mortality. Patients with acute symptomatic seizures in the setting of certain conditions including subdural hemorrhage, traumatic penetrating injuries, cortical strokes, neurocysticercosis, venous sinus thrombosis, and viral encephalitis have a higher rate of seizure recurrence although the rate of recurrence of seizures is less than that of patients with unprovoked seizures.

Summary

In patients with acute symptomatic and provoked seizures, short-term treatment with anti-seizure medications is appropriate given the higher morbidity and mortality in the acute phase of illness. In patients with acute symptomatic seizures with persistent epileptiform activity on EEG and structural changes on imaging, longer-term treatment (i.e., a few months as opposed to 1 week) with anti-seizure medications can be considered due to high risk of seizure recurrence. If a patient subsequently has an unprovoked seizure, there is yet a higher risk of recurrence of seizures and likelihood of the development of epilepsy. In these patients, long-term seizure treatment can be considered, keeping in mind that although anti-seizure treatment may reduce risk of seizure recurrence in the short-term, it does not appear to influence long-term seizure remission rates.

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Authors and Affiliations

  1. Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1137, New York, NY, 10029, USA

    Nisali Gunawardane MD & Madeline Fields MD

  2. The Mount Sinai Epilepsy Center, 1468 Madison Avenue, Annenberg 2nd Floor, New York, NY, 10029, USA

    Nisali Gunawardane MD & Madeline Fields MD

  3. Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA

    Nisali Gunawardane MD & Madeline Fields MD

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  1. Nisali Gunawardane MD
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Correspondence to Nisali Gunawardane MD.

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This article is part of the Topical Collection on Epilepsy

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Gunawardane, N., Fields, M. Acute Symptomatic Seizures and Provoked Seizures: to Treat or Not to Treat?. Curr Treat Options Neurol 20, 41 (2018). https://doi.org/10.1007/s11940-018-0525-2

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