Acute Symptomatic Seizure Management and Epilepsy Development: A Scoping Review
Abstract number :
3.29
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2023
Submission ID :
982
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Vyas Viswanathan, MD – UNC Rex
Marie Byrnes, MD – Resident, Neurology, Cleveland Clinic; Vineet Punia, MD, MS – Staff Physician, Neurology, Cleveland Clinic
Rationale:
Acute symptomatic seizures (ASyS) occur in close temporal relation to systemic or cerebral injury. They account for 40% of all non-febrile seizures. The immediate and long-term management with anti-seizure medications (ASMs) remains controversial. ASyS may not require long-term ASM due to lower risk of recurrence (epilepsy development) compared to remote symptomatic seizures. However, there is limited data and guidelines on specific management strategies for patients with ASyS. We are performing a scoping review of the literature on ASyS management and epilepsy development in adult patients. Our aim is to gain a comprehensive understanding of the current landscape of this topic, identify knowledge gaps, and aid in guiding the direction of future research.
Methods:
Search strategy and study protocol as per PRISMA-SCR guidelines were registered on Open Science Forum. A literature search on ASyS management and seizure recurrence was performed from 06/01/2022 to 06/03/2022. OVID, Embase, Web of Science, and Cochrane Review were queried for publications between 1946 and 06/2022. The search terms are shown in Figure 1. Two independent clinicians (VV, MEB) performed title and abstract (TIAB) screening. Conflicts were resolved through discussion by primary reviewers, followed by a third vote (VP) when required. A full-text review of the selected abstracts was conducted for final inclusion into the scoping review. Primary literature in adult patients who had a seizure within 14 days of acute insult and description of management and/or seizure recurrence were included. Case reports and case series (< 5 patients), gray literature that was later published, medication use for primary prophylaxis, and studies without English translation were excluded. Relevant narrative and systematic reviews were included in the TIAB screening and excluded prior to data extraction to identify predominant literature type on topic.
Results:
After removal of duplicates, a total of 7077 abstracts were included. After TIAB screening, 470 full-texts were reviewed, and 136 studies are included for data extraction. There are more review articles on the topic (n=150) than original research and meta-analyses (n=136). Preliminary results identify five meta-analysis, eight randomized control trials, 19 prospective studies, 86 retrospective studies, and 18 gray literature. Etiology of ASyS include ischemia 29 (21%), autoimmune 15 (11%), infection 15 (11%), withdrawal (8%), hemorrhage 9 (7%), TBI 7 (5%), toxic-metabolic 6 (4%), cardiac arrest 6 (4%), eclampsia 4 (3%), PRES 4 (3%), multiple 31 (23%), and other 8 (6%) (Figure 2).
Conclusions:
Evidence based literature on ASyS management and epilepsy development is limited. We are performing the most thorough literature review on ASyS, which is ubiquitous in inpatient clinical practice. Extant management strategies will be discussed. Prospective studies evaluating optimal treatment strategies for this large and varied patient population is needed.
Funding: None
Anti-seizure Medications