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Treatment of acute and remote symptomatic seizures

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Opinion statement

In principle, the use of anticonvulsant drugs does not differ between acute and remote symptomatic seizures, but control of acute symptomatic seizures requires simultaneous treatment of the underlying etiology. Prevention of remote seizures when the risk is known to be high has been the subject of intense efforts at antiepileptogenesis, but the optimal duration of treatment after an injury is not yet known. Appropriate evaluation of a seizure depends on individual circumstances, but findings on examination, laboratory tests (serum electrolytes, magnesium, glucose, assessment of hepatic and renal function), and brain imaging (CT scan or MRI) are necessary to determine the most likely cause. Lumbar puncture is always required when there is suspicion of meningitis or encephalitis. Preferred medications for treatment of acute symptomatic seizures or status epilepticus are those available for intravenous use, such as benzodiazepines, fosphenytoin or phenytoin, valproate, levetiracetam, and phenobarbital. Diazepam is also available as a gel for rectal administration. Seizures that occur in patients with epilepsy because of missed antiepileptic drugs or inadequate serum levels should be treated with additional doses of their regular medications; loading doses can be administered with minimal toxicity in tolerant patients. Surgery is rarely necessary in the acute setting except for intracerebral lesions with rapidly rising intracranial pressure and impending herniation. After seizures are controlled, the provoking condition must also be determined and treated.

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References and Recommended Reading

  1. Herman ST: Epilepsy after brain insult: targeting epileptogenesis. Neurology 2002, 59:S21–S26.

    PubMed  Google Scholar 

  2. Costello DJ, Cole AJ: Treatment of acute seizures and status epilepticus. J Intensive Care Med 2007, 22:319–347.

    Article  PubMed  Google Scholar 

  3. Mirski MA, Varelas PN: Seizures and status epilepticus in the critically ill. Crit Care Clin 2008, 24:115–147.

    Article  PubMed  CAS  Google Scholar 

  4. Benbir G, Ince B, Bozluolcay M: The epidemiology of poststroke epilepsy according to stroke subtypes. Acta Neurol Scand 2006, 114:8–12.

    Article  PubMed  CAS  Google Scholar 

  5. Alberti A, Paciaroni M, Caso V, et al.: Early seizures in patients with acute stroke: frequency, predictive factors, and effect on clinical outcome. Vasc Health Risk Manag 2008, 4:715–720.

    PubMed  Google Scholar 

  6. Prengler M, Pavlakis SG, Boyd S, et al.: Sickle cell disease: ischemia and seizures. Ann Neurol 2005, 58:290–302.

    Article  PubMed  Google Scholar 

  7. Leone MA, Tonini MC, Bogliun G, et al.: Risk factors for a first epileptic seizure after stroke: a case control study. J Neuro Sci 2009, 277:138–142.

    Article  Google Scholar 

  8. Ryvlin P, Montavont A, Nighoghossian N: Optimizing therapy of seizures in stroke patients [review]. Neurology 2006, 67:S3–S9.

    PubMed  Google Scholar 

  9. Alvarez-Sabín J, Montaner J, Padró L, et al.: Gabapentin in late-onset poststroke seizures. Neurology 2002, 59:1991–1993.

    PubMed  Google Scholar 

  10. Kwan J, Guenther A: Antiepileptic drugs for the primary and secondary prevention of seizures after intracranial venous thrombosis. Cochrane Database Syst Rev 2006, 3:CD005501.

  11. Ferro JM, Canhão P, Bousser M-G, et al., for the ISCVT Investigators: Early seizures in cerebral vein and sinus thrombosis. Stroke 2008, 39:1152–1158.

    Article  PubMed  Google Scholar 

  12. Gilad R, Sadeh M, Rapoport A, et al.: Monotherapy of lamotrigine versus carbamazepine in patients with poststroke seizure. Clin Neuropharm 2007, 30:189–195.

    CAS  Google Scholar 

  13. Rodan LH, Aviv RI, Sahlas DJ: Seizures during stroke thrombolysis heralding dramatic neurologic recovery [case report]. Neurology 2006, 67:2048–2049.

    Article  PubMed  CAS  Google Scholar 

  14. Claassen J, Jetté N, Chum F, et al.: Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology 2007, 69:1356–1365.

    Article  PubMed  CAS  Google Scholar 

  15. Rosengart AJ, Huo JD, Tolentino J, et al.: Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs. J Neurosurg 2007, 107:253–260.

    Article  PubMed  Google Scholar 

  16. Chumnanvej S, Dunn IF, Kim DH: Three-day phenytoin prophylaxis is adequate after subarachnoid hemorrhage. Neurosurgery 2007, 60:99–103.

    Article  PubMed  Google Scholar 

  17. Zubkov AY, Wijdicks EF: Antiepileptic drugs in aneurysmal subarachnoid hemorrhage. Rev Neurol Dis 2008, 5:178–181.

    PubMed  Google Scholar 

  18. Lowenstein D: Epilepsy after head injury: an overview. Epilepsia 2009, 50(Suppl 2):S4–S9.

    Article  Google Scholar 

  19. Ronne-Engstrom E, Winkler T: Continuous EEG monitoring in patients with traumatic brain injury reveals a high incidence of epileptiform activity. Acta Neurol Scand 2006, 114:47–53.

    Article  PubMed  CAS  Google Scholar 

  20. Temkin NR, Dikmen SS, Anderson GD, et al.: Valproate therapy for prevention of posttraumatic seizures: a randomized trial. J Neurosurg 1999, 91:593–600.

    Article  PubMed  CAS  Google Scholar 

  21. Temkin NR: Antiepileptogenesis and seizure prevention trials with antiepileptic drugs: meta-analysis of controlled trials. Epilepsia 2001, 42:515–524.

    Article  PubMed  CAS  Google Scholar 

  22. Milligan TA, Hurwitz S, Bromfield ER: Efficacy and tolerability of levetiracetam versus phenytoin after supratentorial neurosurgery. Neurology 2008, 71:665–669.

    Article  PubMed  CAS  Google Scholar 

  23. Tremont-Lukats IW, Ratilal BO, Armstrong T, Gilbert MR: Antiepileptic drugs for preventing seizures in people with brain tumors. Cochrane Database Syst Rev 2008, CD004424.

  24. Bauer J: Seizure-inducing effects of antiepileptic drugs: a review. Acta Neurol Scand 1996, 94:367–377.

    Article  PubMed  CAS  Google Scholar 

  25. Velio lu SK, Gazio lu S: Non-convulsive status epilepticus secondary to valproic acid-induced hyperammonemic encephalopathy [case report]. Acta Neurol Scand 2007, 116:128–132.

    Article  Google Scholar 

  26. Schwartz MD, Geller RJ: Seizures and altered mental status after lamotrigine overdose [case report]. Ther Drug Monit 2007, 29:843–844.

    Article  PubMed  Google Scholar 

  27. Koppel BS, Hauser WA, Politis C, et al.: Seizures in the critically ill: the role of imipenem. Epilepsia 2001, 42:1590–1593.

    Article  PubMed  CAS  Google Scholar 

  28. Sansone V, Piazza L, Butera G, et al.: Contrast-induced seizures after cardiac catheterization in a 6-year-old child. Pediatr Neurol 2007, 36:268–270.

    Article  PubMed  Google Scholar 

  29. Waring WS, Gray JA, Graham A: Predictive factors for generalized seizures after deliberate citalopram overdose. Br J Clin Pharmacol 2008, 66:861–865.

    Article  PubMed  CAS  Google Scholar 

  30. Ngo A, Ciranni M, Olson KR: Acute quetiapine overdose in adults: a 5-year retrospective case series. Ann Emerg Med 2008, 52:541–547.

    Article  PubMed  Google Scholar 

  31. Kaplan PW, Birbeck G: Lithium-induced confusional states: nonconvulsive status epilepticus or triphasic encephalopathy? Epilepsia 2006, 47:2071–2074.

    Article  PubMed  CAS  Google Scholar 

  32. McKeon A, Frye MA, Delanty N: The alcohol withdrawal syndrome. J Neurol Neurosurg Psych 2008, 79:854–862.

    Article  CAS  Google Scholar 

  33. Brust JC: Seizures, illicit drugs and alcohol. Curr Neurol Neurosci Rep 2008, 8:333–338.

    Article  PubMed  CAS  Google Scholar 

  34. Koppel BS, Samkoff L, Daras M: Relation of cocaine use to seizures and epilepsy. Epilepsia 1996, 37:875–878.

    Article  PubMed  CAS  Google Scholar 

  35. Wiegand T: Phenytoin is not successful in preventing cocaine-induced seizures: a response to cocaine body packing in pregnancy. Ann Emerg Med 2007, 49:543–544.

    Article  PubMed  Google Scholar 

  36. Devlin RJ, Henry JA: Clinical review: major consequences of illicit drug consumption. Crit Care 2008, 12:202.

    Article  PubMed  Google Scholar 

  37. Minozzi S, Amato L, Davoli M, et al.: Anticonvulsants for cocaine dependence. Cochrane Database Syst Rev 2008, 2:CD006754.

  38. Snead OC III, Gibson KM: Gamma-hydroxybutyric acid. N Engl J Med 2005, 352:2721–2732.

    Article  PubMed  CAS  Google Scholar 

  39. Ziai WC, Lewin JJ: Update in the diagnosis and management of central nervous system infections. Neurol Clin 2008, 26:47–68.

    Article  Google Scholar 

  40. Nash TE, Pretell EJ, Lescano AG, et al.: Perilesional brain oedema and seizure activity in patients with calcified neurocysticercosis: a prospective cohort and nested case-control study. Lancet Neurol 2008, 7:1099–1105.

    Article  PubMed  Google Scholar 

  41. Castilla-Guerra L, Fernández-Moreno M, López-Chozas JM, Fernández-Bolaños R: Electrolyte disturbances and seizures. Epilepsia 2006, 47:1990–1998.

    Article  PubMed  CAS  Google Scholar 

  42. Eleftheriadis N, Fourla E, Eleftheriadis D, Karlovasitou A: Status epilepticus as a manifestation of hepatic encephalopathy. Acta Neurol Scand 2003, 107:142–144.

    Article  PubMed  CAS  Google Scholar 

  43. Haut SR, Hall CB, Masur J, Lipton RB: Seizure occurrence: precipitants and prediction. Neurology 2007, 69:1905–1910.

    Article  PubMed  Google Scholar 

  44. Claassen J, Mayer SA, Kowalski RG, et al.: Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004, 62:1743–1748.

    PubMed  CAS  Google Scholar 

  45. Friedman DE, Schevon C, Emerson RG, Hirsch LJ: Cyclic electrographic seizures in critically ill patients. Epilepsia 2009, 49:281–287.

    Article  Google Scholar 

  46. Meierkord H, Holtkamp M: Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology 2008, 70:2015–2016.

    Article  PubMed  Google Scholar 

  47. Treiman DM, Meyers PD, Walton NY, et al.: A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 1998, 339:792–798.

    Article  PubMed  CAS  Google Scholar 

  48. Knake S, Gruener J, Hattemer K, et al.: Intravenous levetiracetam in the treatment of benzodiazepine refractory status epilepticus. J Neurol Neurosurg Psychistry 2008, 79:588–589.

    Article  CAS  Google Scholar 

  49. French JA, Kanner AM, Bautista J, et al.: Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy. Neurology 2004, 62:1252–1260.

    PubMed  CAS  Google Scholar 

  50. Liu L, Henry JC: New-onset partial epilepsy in adults. Curr Treat Options Neurol 2009, 11:242–252.

    Article  Google Scholar 

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Authors and Affiliations

  1. New York Medical College Department of Neurology, Metropolitan Hospital Center, Room 7C5, 1901 First Avenue, New York, NY, 10029, USA

    Barbara S. Koppel

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  1. Barbara S. Koppel
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Correspondence to Barbara S. Koppel.

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Koppel, B.S. Treatment of acute and remote symptomatic seizures. Curr Treat Options Neurol 11, 231–241 (2009). https://doi.org/10.1007/s11940-009-0027-3

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