http://tan.sagepub.com/content/9/5/424?etoc
Abstract
Stroke is among the most common causes of
epilepsy after middle age. Patients with poststroke epilepsy (PSE)
differ in several
respects from patients with other forms of
structural–metabolic epilepsy; not least in age, age-related sensitivity
to side
effects of antiepileptic drugs (AEDs), and specific
drug–drug interaction issues related to secondary-stroke prophylaxis.
Encouragingly, there has lately been remarkable
activity in the study of PSE. Three developments in PSE research deserve
particular
focus. First, large prospective trials have
established the incidence and risk factors of PSE in the setting of
modern stroke
care. Stroke severity, cortical location, young
age, and haemorrhage remain the most important risk factors. Second,
although
more studies are needed, epidemiological data
indicate that the risk of PSE may be influenced, for instance, by statin
treatment.
Third, studies are emerging regarding the treatment
and prognosis of PSE. Levetiracetam and lamotrigine may be well
tolerated
treatment options and seizure freedom is achieved
in at least a similar proportion of patients as in other epilepsies.
Furthermore,
new animal models such as photothrombotic stroke
gives hope of a more clear understanding of PSE epileptogenesis in the
near
future. In summary, PSE shows indications of
maturing into an independent epilepsy research field. This review
summarizes
recent advances in our understanding of PSE and
provides an update on management issues such as diagnosis, AED
selection,
and prognosis. Finally, future research challenges
in the field are outlined.
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