Holtkamp Martin, Beghi Ettore, Benninger Felix, Kälviäinen Reetta, Rocamora Rodrigo, Christensen Hanne
Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Dipartimento di Neuroscienze, Milano, Italy.
Eur Stroke J. 2017 Jun;2(2):103-115. doi: 10.1177/2396987317705536. Epub 2017 Apr 19.
Following stroke, acute symptomatic seizures (manifestation within seven days) and epilepsy, i.e. occurrence of at least one unprovoked seizure (manifestation after more than seven days), are reported in 3-6% and up to 12% of patients, respectively. Incidence of acute symptomatic seizures is higher in intracranial haemorrhage (10-16%) than in ischaemic stroke (2-4%). Acute symptomatic seizures and unprovoked seizure may be associated with unfavourable functional outcome and increased mortality. In view of the clinical relevance, the European Stroke Organisation has issued evidence-based guidelines on the management of post-stroke seizures and epilepsy.
A writing committee of six clinicians and researchers from five European countries and Israel identified seven questions relating to prevention of (further) post-stroke seizures and epilepsy and to amelioration of functional outcome and prevention of mortality. Recommendations are based on findings in randomised controlled trials and observational studies using the grading of recommendations assessment, development and evaluation approach.
In the absence of adequately powered randomised controlled trials, evidence for all recommendations is very low. Based on findings in observational studies, some weak recommendations have been made. In most instances, we suggest not to administer antiepileptic drugs. Due to high incidence of seizure recurrence after one post-stroke unprovoked seizure, secondary antiepileptic drugs prophylaxis needs to be considered.
Due to very low evidence, these guidelines only give some weak recommendations on prevention of occurrence and recurrence of post-stroke acute symptomatic seizures and unprovoked seizure. Adequately powered randomised controlled trials are required to assess interventions for post-stroke seizure management.
中风后，急性症状性癫痫发作（7天内出现）和癫痫，即至少一次无诱因癫痫发作（7天后出现）的报告发生率分别为3%-6%和高达12%的患者。颅内出血（10%-16%）的急性症状性癫痫发作发生率高于缺血性中风（2%-4%）。急性症状性癫痫发作和无诱因癫痫发作可能与不良功能预后及死亡率增加相关。鉴于其临床相关性，欧洲中风组织已发布关于中风后癫痫发作和癫痫管理的循证指南。
一个由来自五个欧洲国家和以色列的六名临床医生和研究人员组成的写作委员会确定了七个与预防（进一步的）中风后癫痫发作和癫痫以及改善功能预后和预防死亡相关的问题。推荐基于使用推荐分级评估、制定和评价方法的随机对照试验和观察性研究结果。
在缺乏足够样本量的随机对照试验的情况下，所有推荐的证据都非常低。基于观察性研究结果，提出了一些弱推荐。在大多数情况下，我们建议不使用抗癫痫药物。由于中风后一次无诱因癫痫发作后癫痫复发率高，需要考虑二级抗癫痫药物预防。
由于证据非常少，这些指南仅对预防中风后急性症状性癫痫发作和无诱因癫痫发作的发生和复发给出了一些弱推荐。需要进行足够样本量的随机对照试验来评估中风后癫痫发作管理的干预措施。
