Acute symptomatic seizure: when and how long to treat

Seizures that occur in close proximity to an event should be considered as situational or acute symptomatic or provoked seizures. By definition, provoked seizures are classified as resulting from transient derangements that involve metabolic, toxic, or medication side-effects, whereas acute symptomatic seizures are caused by an acute event such as stroke, traumatic brain injury (TBI), or CNS infection. 40% of all first Seizures (50% to 70% of Status Epilepticus) are acute symptomatic seizures. These seizures are different from unprovoked seizures both in prognosis and management. In this review we will discuss about therapeutic approach and risk of recurrence of acute symptomatic seizures. In acute phase of brain insult, patients who experience provoked seizures have higher rate of morbidity and mortality. In certain conditions due to higher risk of seizure recurrence, short-term (a few weeks) antiepileptic medications are recommended in acute period (such as penetrating traumatic brain injuries, subdural hematoma, venous sinus thrombosis, viral encephalitis and cortical strokes). In patients with persistent epileptic activity on EEG and structural lesions on imaging longer treatment is recommended (a few months). In patients who have an unprovoked seizure subsequently (> week after an event), long-term medication with antiepileptic drugs should be considered. Multiple studies have confirmed that anti-seizure medications may reduce risk of seizure recurrence in the short-term but it does not appear to alter rate of developing epilepsy in long-term (In other words, anti-seizure medication is not anti-epileptogenic).

Keywords:

Acute symptomatic seizures , Provoked seizures , Antiepileptic drugs