Neurologic Manifestations of Systemic Disease: Seizure
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Neurologic Manifestations of Systemic Disease (D Lapides, Section Editor)
Neurologic Manifestations of Systemic Disease: Seizure Santoshi Billakota, MD* Claude Steriade, MD Jacqueline French, MD Address * Department of Neurology, New York University Langone Comprehensive Epilepsy Center and Grossman School of Medicine, New York, NY, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Neurologic Manifestations of Systemic Disease Keywords Seizure I Epilepsy I Stroke I Autoimmune I Cancer I Toxins I Metabolic
Abstract Purpose of review The goal of this paper is to review the pathophysiology and briefly discuss the management of acute symptomatic seizures secondary to various systemic conditions. Recent findings Seizures are a common first neurological manifestation of systemic conditions and can assist in early recognition and diagnosis of these conditions. This paper reviews acute symptomatic seizures secondary to vascular disease, malignancy, underlying autoimmune etiologies, infection, toxic metabolic conditions, and nutritional causes. Summary Acute symptomatic seizures and systemic conditions have a bidirectional relationship—worsening of one can negatively affect the other. Therefore, increased awareness, knowledge, and management of seizures related to various systemic disorders are paramount in improving the prognosis in these conditions.
Introduction In the USA, 150,000 adults present annually with a first time seizure. Up to 40% of these patients are diagnosed with epilepsy—a predisposition for recurrent, unprovoked seizures [1•]. Roughly 65
million people worldwide have epilepsy [2, 3]. Diagnostic tests such as magnetic resonance imaging (MRI) and electroencephalography (EEG) are often used [4].
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Curr Treat Options Neurol
The focus of this review will be on acute symptomatic seizures in the setting of systemic diseases. We will not
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review primary neurologic conditions which can cause epilepsy, as these can be reviewed in other publications [5].
Vascular disease Stroke The relationship between seizures and cerebrovascular disease (CBVD) is bidirectional [6]. Stroke can lead to acute symptomatic seizures [7]; conversely, a first time seizure may be a clue to occult CBVD [8, 9]. A total of 85% of all strokes are ischemic, whereas 15% are hemorrhagic [10]. Early post-stroke seizure is defined as seizure occurring within 7 days of both ischemic and hemorrhagic stroke with the overall incidence varying between 3.2 and 6.3% [7]. Up to 57% of patients with early seizures will have recurrence following the acute period and resultant epilepsy [11]. Anti-seizure medications (ASMs) are the mainstay for acute symptomatic seizures; however, no ASM has been shown to prevent epilepsy. It is prudent to consider ASM in those with early seizures for 1–6 months, after which ASM taper should be considered with the guidance of an epileptologist [10]. For cortically based hemor
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