TY - JOUR
T1 - Epilepsy in cerebrovascular diseases
T2 - Review of experimental and clinical data with meta-analysis of risk factors
AU - Epilepsy Study Group of the Italian Neurological Society
AU - Ferlazzo, Edoardo
AU - Gasparini, Sara
AU - Beghi, Ettore
AU - Sueri, Chiara
AU - Russo, Emilio
AU - Leo, Antonio
AU - Labate, Angelo
AU - Gambardella, Antonio
AU - Belcastro, Vincenzo
AU - Striano, Pasquale
AU - Paciaroni, Maurizio
AU - Pisani, Laura Rosa
AU - Aguglia, Umberto
N1 - Publisher Copyright:
© 2016 International League Against Epilepsy.
PY - 2016
Y1 - 2016
N2 - Objective: Seizures may occur in close temporal association with a stroke or after a variable interval. Moreover, epilepsy is often encountered in patients with leukoaraiosis. Although early post-stroke seizures have been studied extensively, less attention has been paid to post-stroke epilepsy (PSE) and to epilepsy associated with leukoaraiosis (EAL). The aim of this paper is to review data concerning pathophysiology, prognosis, and treatment of PSE and EAL. Methods: We performed an extensive literature search to identify experimental and clinical articles on PSE and EAL. We also conducted a systematic review of risk factors for PSE and EAL among eligible studies. Results: PSE is caused by enhanced neuronal excitability within and near the scar. The role played by white matter changes in EAL remains to be elucidated. Meta-analysis showed that cortical involvement (odds ratio [OR] 3.71, 95% confidence interval [CI] 2.34–5.90, p < 0.001), cerebral hemorrhage (OR 2.41, 95% CI 1.57–3.70, p < 0.001), and early seizures (OR 4.43, 95% CI 2.36–8.32, p < 0.001) are associated with an increased risk of PSE. As regards EAL, no prospective, population-based studies evaluated the role of different variables on seizure risk. Studies about the management of PSE are limited. PSE is generally well controlled by drugs. Data about risk factors, prognosis, and treatment of EAL are lacking. Significance: Pathophysiology and risk factors are well defined for PSE but need to be elucidated for EAL. Management of PSE and EAL relies on the clinician’s judgment and should be tailored on an individual basis.
AB - Objective: Seizures may occur in close temporal association with a stroke or after a variable interval. Moreover, epilepsy is often encountered in patients with leukoaraiosis. Although early post-stroke seizures have been studied extensively, less attention has been paid to post-stroke epilepsy (PSE) and to epilepsy associated with leukoaraiosis (EAL). The aim of this paper is to review data concerning pathophysiology, prognosis, and treatment of PSE and EAL. Methods: We performed an extensive literature search to identify experimental and clinical articles on PSE and EAL. We also conducted a systematic review of risk factors for PSE and EAL among eligible studies. Results: PSE is caused by enhanced neuronal excitability within and near the scar. The role played by white matter changes in EAL remains to be elucidated. Meta-analysis showed that cortical involvement (odds ratio [OR] 3.71, 95% confidence interval [CI] 2.34–5.90, p < 0.001), cerebral hemorrhage (OR 2.41, 95% CI 1.57–3.70, p < 0.001), and early seizures (OR 4.43, 95% CI 2.36–8.32, p < 0.001) are associated with an increased risk of PSE. As regards EAL, no prospective, population-based studies evaluated the role of different variables on seizure risk. Studies about the management of PSE are limited. PSE is generally well controlled by drugs. Data about risk factors, prognosis, and treatment of EAL are lacking. Significance: Pathophysiology and risk factors are well defined for PSE but need to be elucidated for EAL. Management of PSE and EAL relies on the clinician’s judgment and should be tailored on an individual basis.
KW - Animal models
KW - Antiepileptic drugs
KW - Leukoaraiosis
KW - Seizures
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=84978967717&partnerID=8YFLogxK
U2 - 10.1111/epi.13448
DO - 10.1111/epi.13448
M3 - Review article
SN - 0013-9580
VL - 57
SP - 1205
EP - 1214
JO - Epilepsia
JF - Epilepsia
IS - 8
ER -