Abstracts

In the elderly, stroke is the most common cause of seizures that occur in about 5-10% of cases either as early or late seizures (cut point: two weeks). Most early onset seizures occur within the first 48 hours after stroke. Early seizures are a risk factor for occurrence of late seizures which in turn carry a high risk for epilepsy developing in 35% of early seizures and in 90% of late seizures. The size of regional metabolic dysfunction may be relevant in causing early seizures, whereas permanent lesion can explain higher frequency of epilepsy in patients with late than early seizures. We tested levetiracetam to evaluate its effects on early and late seizures, to verify its effects on avoiding patients to become epileptic and to assess its tolerability. In 2003 we treated 29 patients with stroke-related seizures (first ever seizure or late seizures not treated with antiepileptic drugs in the last three months). Patients were given 1,000-2,000 mg of drug in mono therapy for six months. Follow-up is about six months (study in progress). Demographics: 15 men, 14 women, mean age 74 years (range 57-80); 25 had ischaemic stroke (in more than half of cases , hemispheric parieto-temporal and with a multiinfarct condition) and 4 had cerebral haemorrhage (10% out of 250 and 39, respectively). Early seizures were 10 (9 in ischaemic and 1 in haemorrhagic stroke ); late seizures were 19 (16 in ischaemic and 3 in haemorrhagic stroke). In 16 cases, seizures were initially focal with or without secondary generalisation and in 13 they were apparently generalised [ldquo]d[rsquo]emblee[rdquo]. Among the patients with ischaemic stroke, 7 had atrial fibrillation, 11 had hypertension, 3 were diabetic. Among the haemorrhagic patients, 3 were hypertensive. Recurrence of seizures occurred in only 3 patients (10%),all with ischaemic stroke and late, focal seizures. Despite low titration, in 2 cases patients complained of somnolence that was not so severe to induce the withdrawal of drug. On the basis of these preliminary results, levetiracetam proves to be an effective and safe drug in the treatment of stroke-related seizures.