Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy.
Curr Neuropharmacol. 2023;21(8):1634-1645. doi: 10.2174/1570159X20666220706113925.
Epilepsy is a common comorbidity of cerebrovascular disease and an increasing socioeconomic burden.
We aimed to provide an updated comprehensive review on the state of the art about seizures and epilepsy in stroke, cerebral haemorrhage, and leukoaraiosis.
We selected English-written articles on epilepsy, stroke, and small vessel disease up until December 2021. We reported the most recent data about epidemiology, pathophysiology, prognosis, and management for each disease.
The main predictors for both ES and PSE are the severity and extent of stroke, the presence of cortical involvement and hemorrhagic transformation, while PSE is also predicted by younger age at stroke onset. Few data exist on physiopathology and seizure semiology, and no randomized controlled trial has been performed to standardize the therapeutic approach to post-stroke epilepsy.
Some aspects of ES and PSE have been well explored, particularly epidemiology and risk factors. On the contrary, few data exist on physiopathology, and existing evidence is mainly based on studies on animal models. Little is also known about seizure semiology, which may also be difficult to interpret by non-epileptologists. Moreover, the therapeutic approach needs standardization as regards indications and the choice of specific ASMs. Future research may help to better elucidate these aspects.
癫痫是脑血管病的常见合并症，也是一个日益严重的社会经济负担。
我们旨在提供一篇关于卒中、脑出血和脑白质疏松症中癫痫发作和癫痫的最新综述。
我们选择了截至 2021 年 12 月发表的关于癫痫、卒中及小血管疾病的英文文献。我们报告了每个疾病的最新流行病学、病理生理学、预后和管理数据。
无论是 ES 还是 PSE 的主要预测因素都是卒中的严重程度和范围、皮质受累和出血转化的存在，而 PSE 也与卒中发病时年龄较小有关。关于病理生理学和癫痫发作的临床表现，只有很少的数据，也没有进行随机对照试验来规范卒中后癫痫的治疗方法。
ES 和 PSE 的一些方面已经得到了很好的探讨，特别是流行病学和危险因素。相反，病理生理学方面的数据很少，现有的证据主要基于动物模型的研究。癫痫发作的临床表现也知之甚少，非癫痫学家可能也难以解释。此外，治疗方法需要规范，包括适应证和特定 ASM 的选择。未来的研究可能有助于更好地阐明这些方面。
