Acute Symptomatic Seizures and Provoked Seizures: to Treat or Not to Treat?
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.
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.
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.
KeywordsAcute symptomatic seizures Provoked seizures Unprovoked seizures Remote symptomatic seizures
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 3.• Bergey GK. Management of a first seizure. Continuum (Minneap Minn). 2016;22(1):38–50. Very informative article – provides definition of terms for symptomatic, provoked and unprovoked seizures and includes reference to study on differing recurrence rates among provoked and unprovoked seizures.Google Scholar
- 7.Bert AT. Risk of recurrence after a first unprovoked seizure. Epilepsia. 2008;49:13–8.Google Scholar
- 8.• Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA, et al. Evidence-based guideline: management of an unprovoked first seizure in adults. Neurology. 2015;84:1705–13. This is an important study regarding management of an unprovoked first seizure.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.• Sae-Yeon W, Konczalla J, Dubinski D, Cattani A, Cuca C, Seifert V, et al. A systematic review of epileptic seizure in adults with subdural haematomas. Seizure. 2017;45:28–35. Important paper on incidence of acute symptomatic seizures and risk factors for development of epilepsy in patients with subdural haematomas.CrossRefGoogle Scholar
- 22.Arciniegas DB. Hypoxic-ischemic brain injury. International Brain Injury Association, Alexandria www.internationalbrain.org/articles/hypoxicischemic-brain-injury.
- 37.Ak S, Rajamani K, Whitty JE. Eclampsia: a neurological perspective. J Neurol Sci. 2008;271(1–2):158–67.Google Scholar
- 45.• Nwami PO, Nwosu MC, Nwosu MN. Epidemiology of acute symptomatic seizures among adult medical admissions. Epilepsy Res Treat. 2015; 2016:4718372. 5 pages. https://doi.org/10.1155/2016/4718372. Important study looking at epidemiology of acute symptomatic seizures in a developing country.CrossRefGoogle Scholar
- 53.• Chen W, Li MD, Wang GF, Yang XF, Liu L, Meng FG. Risk of post-traumatic epilepsy after severe head injury in patients with at least one seizure. Neuropsychiatric Disease and Treatment. 2017;13:2301–6. This is an important study looking at risk factors for development of post-traumatic epilepsy. CrossRefPubMedPubMedCentralGoogle Scholar