Neurológia pre prax 4/2011

Acute symptomatic seizures and status epilepticus – definition, causes and treatment

The term acute symptomatic seizure describes a seizure occurring in close temporal relationship with various CNS insults. In contrast to unprovoked seizures, early mortality of acute symptomatic seizures is higher and largely aetiology-dependent. On the other hand, the risk of developing epilepsy following acute symptomatic seizure is lower than in unprovoked seizure. Apart from different pathogenesis, different mechanisms of ictogenesis are implied as well. Acute symptomatic seizures represent approximately 40% of all first seizures. Their aetiology is clearly identifiable – most common causes include cerebrovascular events, CNS injuries, inflammatory disorders of the CNS, metabolic derangements and drug-related and toxic causes, especially alcohol abuse. The most severe form of acute symptomatic seizure is acute symptomatic status epilepticus. Therapy is focused not only on seizure termination, but, more importantly, on treating the underlying aetiology. Therefore, timely ascertainment of the cause is a crucial factor determining the patients´ outcome.

Keywords: acute symptomatic seizures, status epilepticus, epilepsy, provoked seizures.