Beleza Pedro
Department of Neurology, EEG Unit, Espirito Santo Saude Hospitals, Arrabida Hospital and Clipovoa, Póvoa de Varzim, Portugal.
Neurologist. 2012 May;18(3):109-19. doi: 10.1097/NRL.0b013e318251e6c3.
Acute symptomatic seizures are seizures closely related to neurological or systemic insults and represent about 40% of all first seizures. Diagnosis may be difficult to perform due to the subjectivity involved in recognizing the severity of insult needed to provoke epileptic seizures or in determining a clear temporal relationship. Appropriate therapeutic management, risk of developing epilepsy, and mortality depend largely on the underlying disorder.
A general overview regarding definition, epidemiology, and causes of acute symptomatic seizures is provided. Diagnosis, frequency, risk factors, pathophysiology, therapeutic management, and prognosis of acute symptomatic seizures related to each insult individually are discussed. The insults considered are: acute stroke, traumatic brain injury, central nervous system infections, medication, alcohol and illicit drugs, electrolytic and metabolic disorders, anoxic encephalopathy, eclampsia, reversible posterior leukoencephalopathy, and limbic encephalitis.
Operational diagnostic criteria have been recommended by the International League Against Epilepsy and are based on temporal relationship, severity, and type of insult. Antiepileptic drug prophylaxis is recommended in severe head trauma, preeclampsia, and possibly high-risk subarachnoid or intracranial hemorrhage. It is crucial to rapidly identify all insults possibly involved, treat underlying diseases, revert corrigible factors, and in case of central nervous system involvement, use antiepileptic drugs during the acute period. Risk of epilepsy is increased in patients with neurological insults but not with metabolic disorders. Some refractory epilepsies in adults, mostly epilepsy due to hippocampal sclerosis, are preceded by acute symptomatic seizures related to selected insults occurring at a specific time. Mortality rate is globally increased.
急性症状性癫痫发作与神经或全身性损伤密切相关，约占所有首次癫痫发作的40%。由于在识别引发癫痫发作所需损伤的严重程度或确定明确的时间关系时存在主观性，诊断可能难以进行。适当的治疗管理、癫痫发生风险和死亡率在很大程度上取决于潜在疾病。
提供了关于急性症状性癫痫发作的定义、流行病学和病因的总体概述。分别讨论了与每种损伤相关的急性症状性癫痫发作的诊断、频率、危险因素、病理生理学、治疗管理和预后。所考虑的损伤包括：急性中风、创伤性脑损伤、中枢神经系统感染、药物、酒精和非法药物、电解质和代谢紊乱、缺氧性脑病、子痫、可逆性后部白质脑病和边缘叶脑炎。
国际抗癫痫联盟推荐了操作性诊断标准，其基于时间关系、损伤的严重程度和类型。对于严重头部创伤、先兆子痫以及可能的高危蛛网膜下腔或颅内出血，建议预防性使用抗癫痫药物。迅速识别所有可能涉及的损伤、治疗基础疾病、纠正可纠正因素至关重要，并且在中枢神经系统受累的情况下，在急性期使用抗癫痫药物。神经损伤患者的癫痫风险增加，但代谢紊乱患者则不然。成人的一些难治性癫痫，大多是由于海马硬化导致的癫痫，之前会有与特定时间发生的特定损伤相关的急性症状性癫痫发作。总体死亡率增加。
