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2016 ; 9
(5
): 424-35
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Poststroke epilepsy: update and future directions
#MMPMID27582897
Zelano J
Ther Adv Neurol Disord
2016[Sep]; 9
(5
): 424-35
PMID27582897
show ga
Stroke is among the most common causes of epilepsy after middle age. Patients
with poststroke epilepsy (PSE) differ in several respects from patients with
other forms of structural-metabolic epilepsy; not least in age, age-related
sensitivity to side effects of antiepileptic drugs (AEDs), and specific drug-drug
interaction issues related to secondary-stroke prophylaxis. Encouragingly, there
has lately been remarkable activity in the study of PSE. Three developments in
PSE research deserve particular focus. First, large prospective trials have
established the incidence and risk factors of PSE in the setting of modern stroke
care. Stroke severity, cortical location, young age, and haemorrhage remain the
most important risk factors. Second, although more studies are needed,
epidemiological data indicate that the risk of PSE may be influenced, for
instance, by statin treatment. Third, studies are emerging regarding the
treatment and prognosis of PSE. Levetiracetam and lamotrigine may be well
tolerated treatment options and seizure freedom is achieved in at least a similar
proportion of patients as in other epilepsies. Furthermore, new animal models
such as photothrombotic stroke gives hope of a more clear understanding of PSE
epileptogenesis in the near future. In summary, PSE shows indications of maturing
into an independent epilepsy research field. This review summarizes recent
advances in our understanding of PSE and provides an update on management issues
such as diagnosis, AED selection, and prognosis. Finally, future research
challenges in the field are outlined.
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