Advertisement

Medical Management of Seizures in Cerebrovascular Disorders

Chapter

Abstract

Management of seizures and epilepsy in persons who have had a cerebrovascular accident is a complex process involving a number of decisions. Was the event in question an epileptic seizure? If so, should treatment be initiated after a single seizure? If treatment is considered necessary, which antiepileptic drug (AED) should be used to prevent seizure recurrence?

Seizures may present in different settings. Some seizures present in the acute phase of a cerebrovascular accident, often when the patient is in the intensive care unit. Others present weeks or months after a stroke, in which case the recurrence rate is high if untreated, often leading to the diagnosis of epilepsy, rather than single seizures. The pathophysiology, treatment modalities, and consequences of acute poststroke events differ greatly from late seizures and are discussed separately in this chapter. In addition, we discuss the challenges associated with management of seizures and epilepsy in the elderly (Leppik, Walczak, Birnbaum, Lancet, 380:1128–1130, 2012).

Keywords

Seizure Antiepileptic drugs Clinical trials Drug interaction 

References

  1. 1.
    Leppik IE, Walczak TS, Birnbaum AK. Challenges of epilepsy in the elderly. Lancet. 2012;380:1128–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Ferro JM, Pinto F. Poststroke epilepsy: epidemiology, pathophysiology and management. Drugs Aging. 2004;21(10):639–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Forsgren L, Bucht G, Eriksson S, Bergmark L. Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia. 1996;37(3):224–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Cote R, Lebrun L, Pirisi A, Norris JW. Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000;57(11):1617–22.CrossRefPubMedGoogle Scholar
  5. 5.
    Labovitz DL, Hauser WA, Sacco RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology. 2001;57(2):200–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Lamy C, Domigo V, Semah F, Arquizan C, Trystram D, Coste J, Mas JL, Patent Foramen Ovale and Atrial Septal Aneurysm Study Group. Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology. 2003;60(3):400–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Gupta SR, Naheedy MH, Elias D, Rubino FA. Postinfarction seizures. A clinical study. Stroke. 1988;19(12):1477–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Kilpatrick CJ, Davis SM, Hopper JL, Rossiter SC. Early seizures after acute stroke. Risk of late seizures. Arch Neurol. 1992;49(5): 509–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Giroud M, Gras P, Fayolle H, Andre N, Soichot P, Dumas R. Early seizures after acute stroke: a study of 1,640 cases. Epilepsia. 1994;35(5):959–64.CrossRefPubMedGoogle Scholar
  10. 10.
    Ryvlin P, Montavont A, Nighoghossian N. Optimizing therapy of seizures in stroke patients. Neurology. 2006; 67(12 Suppl 4):S3–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Burneo JG, Fang J, Saposnik G, and Investigators of the Registry of the Canadian Stroke Network. Impact of seizures on morbidity and mortality after stroke: a Canadian multi-centre cohort study. Eur J Neurol. 2010;17(1):52–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Kwan J, Wood E. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. Cochrane Database Syst Rev. 2010;2010(1):CD005398.Google Scholar
  13. 13.
    Marigold R, Gunther A, Tiwari D, Kwan J. Antiepileptic drugs for the primary and secondary prevention of seizures after subarachnoid haemorrhage. Cochrane Database Syst Rev. 2013;6:CD008710.PubMedGoogle Scholar
  14. 14.
    Consoli D, Bosco D, Postorino P, Galati F, Plastino M, Perticoni GF, Ottonello GA, Passarella B, Ricci S, Neri G, Toni D, and EPIC Study. Levetiracetam versus carbamazepine in patients with late poststroke seizures: a multicenter prospective randomized open-label study (EpIC Project). Cerebrovasc Dis. 2012;34(4):282–9.Google Scholar
  15. 15.
    Kutlu G, Gomceli YB, Unal Y, Inan LE. Levetiracetam monotherapy for late poststroke seizures in the elderly. Epilepsy Behav. 2008;13(3):542–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Gilad R. Management of seizures following a stroke: what are the options? Drugs Aging. 2012;29(7):533–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C, Kalviainen R, Mattson R, Perucca E, Tomson T. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2006;47(7):1094–120.CrossRefPubMedGoogle Scholar
  18. 18.
    Cervoni L, Artico M, Salvati M, Bristot R, Franco C, Delfini R. Epileptic seizures in intracerebral hemorrhage: a clinical and prognostic study of 55 cases. Neurosurg Rev. 1994;17(3):185–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344(19):1450–60.CrossRefPubMedGoogle Scholar
  20. 20.
    Myint PK, Staufenberg EF, Sabanathan K. Post-stroke seizure and post-stroke epilepsy. Postgrad Med J. 2006;82(971):568–72.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Cusack BJ. Drug metabolism in the elderly. J Clin Pharmacol. 1988;28(6):571–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Ahn JE, Cloyd JC, Brundage RC, Marino SE, Conway JM, Ramsay RE, White JR, Musib LC, Rarick JO, Birnbaum AK, Leppik IE. Phenytoin half-life and clearance during maintenance therapy in adults and elderly patients with epilepsy. Neurology. 2008;71(1):38–43.CrossRefPubMedGoogle Scholar
  23. 23.
    Rowe JW, Andres R, Tobin JD, Norris AH, Shock NW. The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol. 1976;31(2):155–63.CrossRefPubMedGoogle Scholar
  24. 24.
    Fehrman-Ekholm I, Skeppholm L. Renal function in the elderly (> 70 years old) measured by means of iohexol clearance, serum creatinine, serum urea and estimated clearance. Scand J Urol Nephrol. 2004;38(1):73–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Leppik IE, Cloyd JD, Sawchuk RJ, Pepin SM. Compliance and variability of plasmaphenytoin levels in epileptic patients. Ther Drug Mon. 1979;1:475–83.CrossRefGoogle Scholar
  26. 26.
    Graves NM, Holmes GB, Leppik IE. Compliant populations: variability in serum concentrations. Epilepsy Res Suppl. 1988;1:91–9.PubMedGoogle Scholar
  27. 27.
    Privitera MD, Strawsburg RH. 1994. Electroencephalographic monitoring in the emergency department. Emerg Med Clin North Am. 12(4):1089–100.PubMedGoogle Scholar
  28. 28.
    Ramsay R, Rowan A, Slater J, Collins J, Nemire R, Oritz W. Effect of age on epilepsy and its treatment results from the VA cooperative study. Epilepsia. 1994;35 Suppl 8:91.Google Scholar
  29. 29.
    Brodie MJ, Overstall PW, Giorgi L. Multicentre, double-blind, randomised comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. The UK Lamotrigine 1Elderly Study Group. Epilepsy Res. 1999;37(1):81–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Rowan AJ, Ramsay RE, Collins JF, Pryor F, Boardman KD, Uthman BM, Spitz M, Frederick T, Towne A, Carter GS, Marks W, Felicetta J, Tomyanovich ML. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. 2005;64(11):1868–73.CrossRefPubMedGoogle Scholar
  31. 31.
    Mattson RH, Cramer JA, Collins JF, Smith DB, Delgado-Escueta AV, Browne TR, Williamson PD, Treiman DM, McNamara JO, McCutchen CB, et al. Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures. N Engl J Med. 1985;313(3):145–51.CrossRefPubMedGoogle Scholar
  32. 32.
    Ahn J, Cloyd J, Brundage R, Marino S, Conway J, Ramsay R, White J, Musib L, Rarick J, Birnbaum A, Leppik I. Phenytoin half-life and clearance during maintenance therapy in adults and elderly patients with epilepsy. Neurology. 2008;71:38–43.CrossRefPubMedGoogle Scholar
  33. 33.
    Leppik IE. Contemporary diagnosis and management of the patient with epilepsy. 6th ed. Newtown: Handbooks in Healthcare; 2006.Google Scholar
  34. 34.
    Mattson RH, Cramer JA, Collins JF. A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group. N Engl J Med. 1992;327(11):765–71.CrossRefPubMedGoogle Scholar
  35. 35.
    Cloyd JC, Lackner TE, Leppik IE. Antiepileptics in the elderly. Pharmacoepidemiology and pharmacokinetics. Arch Fam Med. 1994;3(7):589–98.CrossRefPubMedGoogle Scholar
  36. 36.
    Graves NM, Brundage RC, Wen Y, Cascino G, So E, Ahman P, Rarick J, Krause S, Leppik IE. Population pharmacokinetics of carbamazepine in adults with epilepsy. Pharmacotherapy. 1998;18(2):273–81.PubMedGoogle Scholar
  37. 37.
    Dong X, Leppik IE, White J, Rarick J. Hyponatremia from oxcarbazepine and carbamazepine. Neurology. 2005;65(12):1976–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Bryson SM, Verma N, Scott PJ, Rubin PC. Pharmacokinetics of valproic acid in young and elderly subjects. Br J Clin Pharmacol. 1983;16(1):104–5.CrossRefPubMedCentralPubMedGoogle Scholar
  39. 39.
    Perucca E, Grimaldi R, Gatti G, Pirracchio S, Crema F, Frigo GM. Pharmacokinetics of valproic acid in the elderly. Br J Clin Pharmacol. 1984;17(6):665–9.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Birnbaum AK, Hardie NA, Conway JM, Bowers SE, Lackner TE, Graves NM, Leppik IE. Valproic acid doses, concentrations, and clearances in elderly nursing home residents. Epilepsy Res. 2004;62(2–3):157–62.CrossRefPubMedGoogle Scholar
  41. 41.
    Richens A. Clinical pharmacokinetics of gabapentin. London: Royal Society of Medicine Services; 1993.Google Scholar
  42. 42.
    Peck AW. Clinical pharmacology of lamotrigine. Epilepsia. 1991;32 Suppl 2:S9–12.CrossRefPubMedGoogle Scholar
  43. 43.
    Hussein Z, Posner J. Population pharmacokinetics of lamotrigine monotherapy in patients with epilepsy: retrospective analysis of routine monitoring data. Br J Clin Pharmacol. 1997;43(5):457–65.CrossRefPubMedCentralPubMedGoogle Scholar
  44. 44.
    Rowan A, Ramsay R, Collins J, et al. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. 2005;64:1868–73.CrossRefPubMedGoogle Scholar
  45. 45.
    Patsalos PN, Sander JW. Newer antiepileptic drugs. Towards an improved risk-benefit ratio. Drug Saf. 1994;11(1):37–67.CrossRefPubMedGoogle Scholar
  46. 46.
    French J. Use of levetiracetam in special populations. Epilepsia. 2001;42 Suppl 4:40–3.CrossRefPubMedGoogle Scholar
  47. 47.
    Morrell MJ, Leppik I, French J, Ferrendelli J, Han J, Magnus L. The KEEPER trial: levetiracetam adjunctive treatment of partial-onset seizures in an open-label community-based study. Epilepsy Res. 2003;54(2–3):153–61.CrossRefPubMedGoogle Scholar
  48. 48.
    Cramer JA, Leppik IE, Rue KD, Edrich P, Kramer G. Tolerability of levetiracetam in elderly patients with CNS disorders. Epilepsy Res. 2003;56(2–3):135–45.CrossRefPubMedGoogle Scholar
  49. 49.
    Leppik IE, Willmore LJ, Homan RW, From G, Oommen KJ, Penry JK, Sackellares JC, Smith DB, Lesser RP, Wallace JD, Trudeau JL, Lamoreaux LK, Spencer M. Efficacy and safety of zonisamide: results of a multicenter study. Epilepsy Res. 1993;14:165–73.CrossRefPubMedGoogle Scholar
  50. 50.
    Wroe O. Zonisamide and renal calculi in patients with epilepsy: how big an issue? Curr Med Res Opin. 2007;23(8):1765–73.CrossRefPubMedGoogle Scholar
  51. 51.
    Nation RL, Evans AM, Milne RW. Pharmacokinetic drug interactions with phenytoin (Part I). Clin Pharmacokinet. 1990a;18(1):37–60.CrossRefPubMedGoogle Scholar
  52. 52.
    Nation RL, Evans AM, Milne RW. Pharmacokinetic drug interactions with phenytoin (Part II). Clin Pharmacokinet. 1990b;18(2):131–50.CrossRefPubMedGoogle Scholar
  53. 53.
    Bollini P, Riva R, Albani F, Ida N, Cacciari L, Bollini C, Baruzzi A. Decreased phenytoin level during antineoplastic therapy: a case report. Epilepsia. 1983;24(1):75–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Neef C, de Voogd-van der Straaten I. An interaction between cytostatic and anticonvulsant drugs. Clin Pharmacol Ther. 1988;43(4):372–5.CrossRefPubMedGoogle Scholar
  55. 55.
    Haley CJ, Nelson J. Phenytoin-enteral feeding interaction. Dicp—Ann Pharmacother. 1989;23(10):796–8.Google Scholar
  56. 56.
    Sandor P, Sellers EM, Dumbrell M, Khouw V. Effect of short- and long-term alcohol use on phenytoin kinetics in chronic alcoholics. Clin Pharmacol Ther. 1981;30(3):390–7.CrossRefPubMedGoogle Scholar
  57. 57.
    Cold JA, Wells BG, Froemming JH. Seizure activity associated with antipsychotic therapy. Dicp—Ann Pharmacother. 1990;24(6):601–6.Google Scholar
  58. 58.
    Alvarez-Sabin J, Montaner J, Padro L, Molina CA, Rovira R, Codina A, Quintana M. Gabapentin in late-onset poststroke seizures. Neurology. 2002;59(12):1991–3.CrossRefPubMedGoogle Scholar
  59. 59.
    Belcastro V, Vidale S, Pierguidi L, Sironi L, Tancredi L, Striano P, Taborelli A, Arnaboldi M. Intravenous lacosamide as treatment option in post-stroke non convulsive status epilepticus in the elderly: a proof-of-concept, observational study. Seizure. 2013;22(10):905–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Carrera E, Michel P, Despland PA, Maeder-Ingvar M, Ruffieux C, Debatisse D, Ghika J, Devuyst G, Bogousslavsky J. Continuous assessment of electrical epileptic activity in acute stroke. Neurology. 2006;67(1):99–104.CrossRefPubMedGoogle Scholar
  61. 61.
    Dawling S, Crome P. Clinical pharmacokinetic considerations in the elderly. An update. Clin Pharmacokinet. 1989;17(4):236–63.CrossRefPubMedGoogle Scholar
  62. 62.
    Greenblatt DJ. Reduced serum albumin concentration in the elderly: a report from the Boston collaborative drug surveillance program. J Am Geriatr Soc. 1979;27(1):20–2.CrossRefPubMedGoogle Scholar
  63. 63.
    Jordan KG. Continuous EEG and evoked potential monitoring in the neuroscience intensive care unit. J Clin Neurophysiol. 1993;10(4):445–75.CrossRefPubMedGoogle Scholar
  64. 64.
    Nelson MH, Birnbaum AK, Remmel RP. Inhibition of phenytoin hydroxylation in human liver microsomes by several selective serotonin re-uptake inhibitors. Epilepsy Res. 2001;44(1):71–82.CrossRefPubMedGoogle Scholar
  65. 65.
    Tiula E, Neuvonen PJ. Antiepileptic drugs and alpha 1-acid glycoprotein. N Engl J Med. 1982;307(18):1148.PubMedGoogle Scholar
  66. 66.
    Towne AR, Waterhouse EJ, Boggs JG, Garnett LK, Brown AJ, Smith JR, Jr., DeLorenzo RJ. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000;54(2):340–5.CrossRefPubMedGoogle Scholar
  67. 67.
    Verbeeck RK, Cardinal JA, Wallace SM. Effect of age and sex on the plasma binding of acidic and basic drugs. Eur J Clin Pharmacol. 1984;27(1):91–7.CrossRefPubMedGoogle Scholar
  68. 68.
    Wallace S, Verbeeck R. Effect of age and sex on the plasma binding of acidic and basic drugs. Clin Pharmacokinet. 1987;12:91–7.CrossRefGoogle Scholar
  69. 69.
    Wynne HA, Cope LH, Mutch E, Rawlins MD, Woodhouse KW, James OF. The effect of age upon liver volume and apparent liver blood flow in healthy man. Hepatology. 1989;9(2):297–301.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of NeurologyThe George Washington Medical Faculty AssociatesWashingtonUSA
  2. 2.Department of Neurology & PharmacyUniversity of MinnesotaMinneapolisUSA

Personalised recommendations