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Θεραπεία οξείας επιληπτικής κρίσης και επιληψίας σε ΑΕΕ (Master thesis)

Βελίτσος, Ιωάννης

Stroke is the most common cause of structural epilepsy in adults. The occurrence of seizures especially in the acute phase of a stroke appears to be associated with severe complications, clinical deterioration, worse prognosis and increased mortality. Seizures after stroke are divided into acute- (provoked) and late- (unprovoked) onset, depending on the time of their manifestation. Despite the possible association between acute and late seizures and their potential negative effects on the clinical outcome, their different pathophysiological background, the generally low probability of the occurrence and recurrence of acute seizures, the questionable protection of antiepileptic drugs (AEDs) in the process of epileptogenesis, the possibility of serious side effects due to their use and the absence of sufficient studies on safety and effectiveness of AEDs do not encourage the initiation of primary prophylactic antiepileptic treatment, except in those cases where the probability of an acute or delayed seizure exceeds 50%. Many different factors, who predispose to poststroke epileptic phenomena, have been recognised, while simultaneously a series of scales have been proposed (SeLECT, CAVE, etc.), which can be used as predictive models. The contribution of the simple and especially the continuous electroencephalography is also particularly important in the identification of patients with an increased risk of manifestation of provoked and/or unprovoked seizures. The therapeutic strategy differs after manifestation of acute or late seizures. In the first case, the approach of clinicians is often individualized, being more aggressive in cases of intracranial bleeding or cerebral venous thrombosis, while in the second case, the diagnosis of symptomatic epilepsy can be established with the initiation of secondary prophylaxis being the choice. Therapeutically, acute and delayed-onset seizures after stroke must be approached exactly as in the case of seizures of different etiology. Factors such as the type of epilepsy, the particular profile of the patient (gender, age, comorbidity and co-medication), the pharmacokinetic and pharmacodynamic interactions between antiepileptics themselves and finally issues such as safety, tolerability and sufficiently documented efficacy should be seriously considered in the final pharmaceutic choice, which ideally includes monotherapy at the lowest possible dosage.