European Stroke Organisation (ESO) guidelines on the management of post-stroke seizures and epilepsy

Published by ESO on May 11, 2021

Disclaimer

The authors declared the following potential conflicts of interest with respect to authorship, and/or publication of this article: MH received speaker’s honoraria and/or consultancy fees from Cyberonics, Desitin, Eisai, GlaxoSmithKline, Janssen- Cilag, Novartis, UCB Pharma and Viropharma. EB received grants from the Italian Ministry of Health, Italian Drug Agency, UCB Pharma, EISAI, Shire, American ALS Association, Borgonovo, Foundation, consultancy fees from Viropharma. RK received Speaker’s honoraria and/or consultancy fees from Eisai, Fennomedical, GW Pharmaceuticals, Orion, Sage, Sandoz and UCB Pharma. The other authors declare that there is no conflict of interest.

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This guideline development received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors.

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Abstract

Background: Following stroke, acute symptomatic seizures (manifestation within seven days) and epilepsy, i.e. occurrence of at least one unprovoked seizure (manifestation after more than seven days), are reported in 3–6% and up to 12% of patients, respectively. Incidence of acute symptomatic seizures is higher in intracranial haemorrhage (10–16%) than in ischaemic stroke (2–4%). Acute symptomatic seizures and unprovoked seizure may be associated with unfavourable functional outcome and increased mortality. In view of the clinical relevance, the European Stroke Organisation has issued evidence-based guidelines on the management of post-stroke seizures and epilepsy. Method: A writing committee of six clinicians and researchers from five European countries and Israel identified seven questions relating to prevention of (further) post-stroke seizures and epilepsy and to amelioration of functional outcome and prevention of mortality. Recommendations are based on findings in randomised controlled trials and observational studies using the grading of recommendations assessment, development and evaluation approach. Results: In the absence of adequately powered randomised controlled trials, evidence for all recommendations is very low. Based on findings in observational studies, some weak recommendations have been made. In most instances, we suggest not to administer antiepileptic drugs. Due to high incidence of seizure recurrence after one post-stroke unprovoked seizure, secondary antiepileptic drugs prophylaxis needs to be considered. Conclusion: Due to very low evidence, these guidelines only give some weak recommendations on prevention of occurrence and recurrence of post-stroke acute symptomatic seizures and unprovoked seizure. Adequately powered randomised controlled trials are required to assess interventions for post-stroke seizure management.

Language

en

PICOS

PICO 1.1

Population
Adults with ischemic stroke or intracranial haemorrhage
Intervention
Immediate primary prophylaxis with an antiepileptic drug
Comparator
No treatment
Outcomes

PICO 5.1

Population
Adults with ischaemic stroke or intracranial haemorrhage
Intervention
Immediate but temporary pharmacological treatment
Comparator
No treatment
Outcomes

PICO 7.1

Population
Adults with ischaemic stroke or intracranial haemorrhage
Intervention
Antiepileptic drug
Comparator
No treatment
Outcomes