Acute Symptomatic Seizures: to Treat or Not to Treat

Purpose of review: Acute symptomatic and provoked seizures by definition occur in close proximity to an event and are considered to be situational. A number of population studies, including some classic reports, have identified the relative risk factors for subsequent seizure recurrence. In this article, the authors review the literature on acute symptomatic and provoked seizures with regard to therapeutic approach and risk of recurrence. Methods: Systematic review of the literature and of epidemiologic studies.Result: Multiple seizures in a given 24-hour period do not increase the risk of seizure recurrence. Remote symptomatic seizures, an epileptiform EEG, a significant brain imaging abnormality, and nocturnal seizures are risk factors for seizure recurrence. Patients with acute symptomatic seizures in the setting of certain conditions including subdural hemorrhage, traumatic penetrating injuries, cortical strokes, neurocysticercosis, venous sinus thrombosis, and viral encephalitis have a higher rate of seizure recurrence although the rate of recurrence of seizures is less than that of patients with unprovoked seizures. Conclusion: In patients with acute symptomatic and provoked seizures, short-term treatment with anti-seizure medications is appropriate. In patients with acute symptomatic seizures with persistent epileptiform activity on EEG and structural changes on imaging, longer-term treatment (i.e., a few months as opposed to 1week) with anti-seizure medications can be considered due to high risk of seizure recurrence. If a patient subsequently has an unprovoked seizure, there is yet a higher risk of recurrence of seizures and likelihood of the development of epilepsy. In these patients, long-term seizure treatment can be considered, keeping in mind that although anti-seizure treatment may reduce risk of seizure recurrence in the short-term, it does not appear to influence long-term seizure remission rates.

Keywords:

Acute symptomatic seizure , treatment , seizure recurrence risk