Abstracts

Rationale: Stroke is a frequent cause of epilepsy in adults, particularly in individuals over 60 years. Post-stroke seizures (PSS) are classified as early PSS (EPSS) when occurring within 14 days after stroke or late PSS (LPSS) when occurring more than 2 weeks after stroke. The risk of experiencing LPSS is 3 to 5% in the first year after stroke and 1 to 2% thereafter. This represents approximately a 20-fold increase in the relative risk of seizures (Ss) compared with the population of the same age without stroke. The frequency of Ss after ischemic stroke (IS) varies from 1.8 to 43%, depending on Ss type, duration of follow-up, and study design. Epilepsy (ie. recurrent seizures) (RS) develops from 2.5% to 4% of the stroke patients. The aim of this study is to describe the effectiveness and safety of LEV in monotherapy in patients with EPSS in preventing a LPSS, and/or preventing RS. Methods: 650 (300 M,350 F) patients (Pts), (mean age of 75.7 years), admitted under department of Neurology of Hospital “Rummo”,Benevento (I), with the diagnosis of IS between January 2005 to December 2008, were studied. Of 37 (17 M, 20 F) Pts, presenting EPSS, 19 (8 M,11 F)Pts were treated with LEV 1000-2000 mg/die. Of 38 (18 M,20 F)Pts with LPSS, but not EPSS, 19 (8 M,11 F)Pts were treated with LEV 1000-2000 mg/die only when presenting LPSS. All patients with history of previous S, previous brain surgery, head trauma, hemorrhagic stroke, tumour, significant metabolic abnormality and septicaemia were excluded. MRI or CT scan of head and EEG were performed in all the Pts. Reasons for study withdrawal included inability to control seizures, drug intolerance, death and patient request. Tolerability was assessed by monitoring of possible side effects (SE). Results: 75 (11.5%)Pts, (mean age:76.6 years,mean follow-up 12 ± 4.5 months), reported PSS. Out of 37(49.3 %)Pts presenting EPSS, 19(51.3%)Pts were treated with LEV, and 2(10.5%)Pts experienced LPSS. In 18(47.7%)Pts, not treated with LEV, 8(47.0%)Pts had LPSS. Out of 38(50.7%)Pts,with LPSS and not previous EPSS and not anti-epileptic treatment, 20(52.6%)Pts, were treated with LEV and 4(20%)Pts experienced RS. Of 18(47.4%)Pts,not treated with LEV, 10(55.5%) had a RS. At the end of follow-up, 94.5% of Pts treated with LEV were free from S. SE that could be attributed to LEV were noted by 12.6% of patients, but did not compel them to stop treatment. Conclusions: Of 650 Pts with IS, 75(11.5%)Pts experienced PSS. 37(5.6%)Pts had EPSS and 30(6.1%)Pts had LPSS. Of 19(51.3%)Pts, with EPSS and treated with LEV, 2(10.5%) had LPSS while of 18(47.7%)Pts, not treated with LEV, 8(44.4%)Pts experienced LPSS. Of 20(52.6%)Pts, with LPSS and not EPSS, treated with LEV, 4(20%)Pts had RS while of 18(47.4%)Pts with LPSS and not EPSS, not treated with LEV, 10(55.5%)Pts had a RS. LEV in monotherapy can be a safe, effective therapeutic option for Pts who have presented seizures following an IS in preventing LPSS and RS.