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Review
. 2023;21(8):1634-1645.
doi: 10.2174/1570159X20666220706113925.

Epilepsy in Cerebrovascular Diseases: A Narrative Review

Sabrina Neri  1   2 , Sara Gasparini  1   2 , Angelo Pascarella  1   2 , Domenico Santangelo  1   2 , Vittoria Cianci  2 , Anna Mammì  1 , Michele Lo Giudice  1 , Edoardo Ferlazzo  1   2 , Umberto Aguglia  1   2
Affiliations
Review

Epilepsy in Cerebrovascular Diseases: A Narrative Review

Sabrina Neri et al. Curr Neuropharmacol. 2023.

Abstract

Background: Epilepsy is a common comorbidity of cerebrovascular disease and an increasing socioeconomic burden.

Objective: We aimed to provide an updated comprehensive review on the state of the art about seizures and epilepsy in stroke, cerebral haemorrhage, and leukoaraiosis.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Seizures; cerebral haemorrhage; cerebrovascular disease; epilepsy; leukoaraiosis; post-stroke epilepsy; stroke.

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Conflict of interest statement

The authors declare no conflict of interest, financial or otherwise.

Figures

Fig. (1)
Fig. (1)
Mechanism of action of clinically approved anti-seizure drugs. Drugs marked with asterisks indicate that these compounds act by multiple mechanims (not all mechanisms shown here). GABA-T GABA aminotransferase, GAT GABA transporter, SV2A synaptic vesicle protein 2A, GABA gamma-aminobutyric acid, NMDA N-methyl-D-aspartate, AMPA α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, KCNQ a family of voltage-gated potassium channels (also known as the Kv7 family). Reprinted from CNS Drugs, 30, Löscher W, Gillard M, Sands ZA, Kaminski RM, Klitgaard H, Synaptic Vesicle Glycoprotein 2A Ligands in the Treatment of Epilepsy and Beyond, pages 1055-1077, Copyright @ 2016, with permission from Springer Nature. Reprints and Permissions.
See this image and copyright information in PMC

References

    1. Hauser W.A., Annegers J.F., Kurland L.T. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984. Epilepsia. 1993;34(3):453–468. doi: 10.1111/j.1528-1157.1993.tb02586.x. - DOI - PubMed
    1. Koubeissi M. Seizures worsen stroke outcome: New evidence from a large sample. Epilepsy Curr. 2015;15(1):30–31. doi: 10.5698/1535-7597-15.1.30. - DOI - PMC - PubMed
    1. Beghi E., Carpio A., Forsgren L., Hesdorffer D.C., Malmgren K., Sander J.W., Tomson T., Hauser W.A. Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010;51(4):671–675. doi: 10.1111/j.1528-1167.2009.02285.x. - DOI - PubMed
    1. Ferlazzo E., Gasparini S., Beghi E., Sueri C., Russo E., Leo A., Labate A., Gambardella A., Belcastro V., Striano P., Paciaroni M., Pisani L.R., Aguglia U. Epilepsy in cerebrovascular diseases: Review of experimental and clinical data with meta-analysis of risk factors. Epilepsia. 2016;57(8):1205–1214. doi: 10.1111/epi.13448. - DOI - PubMed
    1. Pezzini A., Grassi M., Del Zotto E., Giossi A., Volonghi I., Costa P., Poli L., Morotti A., Gamba M., Ritelli M., Colombi M., Padovani A. Complications of acute stroke and the occurrence of early seizures. Cerebrovasc. Dis. 2013;35(5):444–450. doi: 10.1159/000348704. - DOI - PubMed