Timing of long term antiepileptic drug therapy for stroke related seizures_Journal of Epilepsy

Authors：

LILiting ¹ ,  YUQing ¹ , YANXinxin ¹ , YUDanhua ¹ , CHENYing ¹ , YAOXiaojuan ¹ , YANGWeidong ² , CHENZhijuan ²

1. Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China;
2. Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China;

Corresponding author：

YUQing, Email: yq_yuqing@163.com

Keywords：

Post-stroke seizures; Early-onset seizure; Late-onset seizure; Timing of treatment; Antiepileptic drugs

DOI：

10.7507/2096-0247.20170003

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Objective This study aimed to explore the timing of the long-term antiepileptic drugs (AEDs) therapy in patients with stroke related seizures. Methods We enrolled 90 Patients with post-stroke seizures who diagnosed in neurology and epilepsy specialist clinic of Tianjin Medical University General Hospital and followed up for at least 12 months from September 2014 to August 2016. The patients were divided into early-onset seizure group (occurring within 2 weeks of stroke) and late-onset seizure group (occurring after 2 weeks of stroke).The two groups were subdivided into treated and untreated group after the first seizure. Results The patients were followed up for 12~96m (median 20m). 31 patients in ES group, 19 of which in treated group and 12 of which in untreated group. 59 patients in LS group, 36 of which in treated group and 23 of cases in untreated group. The recurrence rate of second seizures occurred in each group and the comparison between the subgroups in the 3rd, 6th, 9th and 12th mouth of follow-up as follows. 1 LS group compared with the group of ES, the recurrence rate of second seizures was high (25.81%~38.71% vs. 49.15%~69.49%), and there was statistical difference (P < 0.05). 2 The recurrence rate of ES in untreated group was lower than that in untreated LS group (16.77% 33.33% vs. 56.52% 73.91%), but only in 3m and 12m the difference was statistically significant (P < 0.05). 3 There was on statistically significant different in ES treated group compared to untreated group, LS treated group compared to untreated group, ES treated group compared to LS treated group (P > 0.05). Both in group of ES and LS, The ratio of seizure recurred patients at different time points during follow-up period was highest at the time of 3m, 3 6m followed, within six months respectively as high as 91.67% and 76.59%. Conclusion Only one early-onset seizure after stroke can be suspended long-term AEDs treatment, once it recurred that indicates the need for treatment. However, the recurrence rate of late-onset seizure was higher than that of early-onset seizure and it should be given long term AEDs treatment after the first seizure.

Citation： LILiting, YUQing, YANXinxin, YUDanhua, CHENYing, YAOXiaojuan, YANGWeidong, CHENZhijuan. Timing of long term antiepileptic drug therapy for stroke related seizures. Journal of Epilepsy, 2017, 3(1): 22-26. doi: 10.7507/2096-0247.20170003 Copy

1.	Zaccara G, Perucca E. Interactions between antiepileptic drugs, and between antiepileptic drugs and other drugs. Epileptic Disord, 2014, 16(4):409-431.
2.	刘晓燕.临床脑电图学.北京:人民卫生出版社, 2006:1-664.
3.	Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report:a practical clinical definition of epilepsy. Epilepsia, 2014, 55(4):475-482.
4.	Neligan A, Hauser WA, Sander JW. The epidemiology of the epilepsies. Handbook of Clinical Neurology, 2012, 107:113-133.
5.	Cleary P, Shorvon S, Tallis R. Late-onset seizures as a predictor of subsequent stroke. Lancet, 2004, 363(9416):1184-1186.
6.	Ryvlin P, Montavont A, Nighoghossian N. Optimizing therapy of seizures in stroke patients. Neurology, 2006, 67(12 Suppl 4):3-9.
7.	Rosengart AJ, Huo JD, Tolentino J, et al. Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs. Journal of Neurosurgery, 2007, 107(2):253-260.
8.	Reddig RT, Nixdorf KE, Jensen MB. The prophylactic use of an antiepileptic drug in intracerebral hemorrhage. Clinical Neurology and Neurosurgery, 2011, 113(10):895-897.
9.	Kwan J, Wood E. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. The Cochrane database of systematic reviews, 2010, 1):CD005398.
10.	Marson A, Jacoby A, Johnson A, et al. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures:a randomised controlled trial. Lancet, 2005, 365(9476):2007-2013.
11.	Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. First Seizure Trial Group (FIR.S.T. Group). Neurology, 1993, 43(3 Pt 1):478-483.
12.	Hamer HM. Seizures and epilepsies after stroke. Der Nervenarzt, 2009, 80(4):405-414.
13.	Menon B, Shorvon SD. Ischaemic stroke in adults and epilepsy. Epilepsy Research, 2009, 87(1):1-11.
14.	Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke:a prospective multicenter study. Archives of Neurology, 2000, 57(11):1617-1622.
15.	De Lorenzo RJ, Sun DA, Blair RE, et al. An in vitro model of stroke-induced epilepsy:elucidation of the roles of glutamate and calcium in the induction and maintenance of stroke-induced epileptogenesis. International Review of Neurobiology, 2007, 81(7):59-84.
16.	Nunes VD, Sawyer L, Neilson J, et al. Diagnosis and management of the epilepsies in adults and children:summary of updated NICE guidance. BMJ, 2012, 344:e281.
17.	Beghi E, Carpio A, Forsgren L, et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia, 2010, 51(4):671-675.
18.	Zhang C, Wang X, Wang Y, et al. Risk factors for post-stroke seizures:a systematic review and meta-analysis. Epilepsy Research, 2014, 108(10):1806-1816.
19.	Pezzini A, Grassi M, Del Zotto E, et al. Complications of acute stroke and the occurrence of early seizures. Cerebrovascular Diseases, 2013, 35(5):444-450.
20.	Jungehulsing GJ, Heuschmann PU, Holtkamp M, et al. Incidence and predictors of post-stroke epilepsy. Acta Neurologica Scandinavica, 2013, 127(6):427-430.

1. Zaccara G, Perucca E. Interactions between antiepileptic drugs, and between antiepileptic drugs and other drugs. Epileptic Disord, 2014, 16(4):409-431.
2. 刘晓燕.临床脑电图学.北京:人民卫生出版社, 2006:1-664.
3. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report:a practical clinical definition of epilepsy. Epilepsia, 2014, 55(4):475-482.
4. Neligan A, Hauser WA, Sander JW. The epidemiology of the epilepsies. Handbook of Clinical Neurology, 2012, 107:113-133.
5. Cleary P, Shorvon S, Tallis R. Late-onset seizures as a predictor of subsequent stroke. Lancet, 2004, 363(9416):1184-1186.
6. Ryvlin P, Montavont A, Nighoghossian N. Optimizing therapy of seizures in stroke patients. Neurology, 2006, 67(12 Suppl 4):3-9.
7. Rosengart AJ, Huo JD, Tolentino J, et al. Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs. Journal of Neurosurgery, 2007, 107(2):253-260.
8. Reddig RT, Nixdorf KE, Jensen MB. The prophylactic use of an antiepileptic drug in intracerebral hemorrhage. Clinical Neurology and Neurosurgery, 2011, 113(10):895-897.
9. Kwan J, Wood E. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. The Cochrane database of systematic reviews, 2010, 1):CD005398.
10. Marson A, Jacoby A, Johnson A, et al. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures:a randomised controlled trial. Lancet, 2005, 365(9476):2007-2013.
11. Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. First Seizure Trial Group (FIR.S.T. Group). Neurology, 1993, 43(3 Pt 1):478-483.
12. Hamer HM. Seizures and epilepsies after stroke. Der Nervenarzt, 2009, 80(4):405-414.
13. Menon B, Shorvon SD. Ischaemic stroke in adults and epilepsy. Epilepsy Research, 2009, 87(1):1-11.
14. Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke:a prospective multicenter study. Archives of Neurology, 2000, 57(11):1617-1622.
15. De Lorenzo RJ, Sun DA, Blair RE, et al. An in vitro model of stroke-induced epilepsy:elucidation of the roles of glutamate and calcium in the induction and maintenance of stroke-induced epileptogenesis. International Review of Neurobiology, 2007, 81(7):59-84.
16. Nunes VD, Sawyer L, Neilson J, et al. Diagnosis and management of the epilepsies in adults and children:summary of updated NICE guidance. BMJ, 2012, 344:e281.
17. Beghi E, Carpio A, Forsgren L, et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia, 2010, 51(4):671-675.
18. Zhang C, Wang X, Wang Y, et al. Risk factors for post-stroke seizures:a systematic review and meta-analysis. Epilepsy Research, 2014, 108(10):1806-1816.
19. Pezzini A, Grassi M, Del Zotto E, et al. Complications of acute stroke and the occurrence of early seizures. Cerebrovascular Diseases, 2013, 35(5):444-450.
20. Jungehulsing GJ, Heuschmann PU, Holtkamp M, et al. Incidence and predictors of post-stroke epilepsy. Acta Neurologica Scandinavica, 2013, 127(6):427-430.

Journal of Epilepsy

Timing of long term antiepileptic drug therapy for stroke related seizures

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