Klinische Neurophysiologie 2002; 33(2): 63-69
DOI: 10.1055/s-2002-32777
Originalia
© Georg Thieme Verlag Stuttgart · New York

Schlaganfall: Epilepsie und Rolle des EEG

Stroke: Epilepsy and the Role of EEGL.  Weitemeyer1 , P.  Lüdemann1 , H.  Henningsen1
  • 1Klinik für Neurologie, Universitätsklinikum Münster
Further Information

Publication History

Publication Date:
12 July 2002 (online)

Zusammenfassung

Zerebrovaskuläre Erkrankungen sind die bedeutendste Ursache von epileptischen Anfällen und einer symptomatischen fokalen Epilepsie im höheren Lebensalter. Etwa 10 % der Patienten erleiden innerhalb der ersten fünf Jahre nach einem akuten Insult zumindest einen symptomatischen epileptischen Anfall. In ungefähr der Hälfte der Fälle handelt es sich um Frühanfälle innerhalb der ersten zwei Wochen. Das Risiko der Entwicklung einer Epilepsie ist besonders nach Spätanfällen erhöht und beträgt ca. 3 - 5 %. Schlaganfalltyp, -lokalisation und -ätiologie, die Schwere des initialen neurologischen Defizits, eine Kortexbeteiligung, erhaltene Kortexinseln im Infarktareal sowie die Menge des zisternalen Blutes bei Patienten mit Subarachnoidalblutungen beeinflussen in unterschiedlichem Maße die Wahrscheinlichkeit des Auftretens epileptischer Anfälle oder einer Epilepsie. Patienten, bei denen in der Akutphase mittels EEG periodische lateralisierte epileptiforme Entladungen (PLEDs) abgeleitet werden können, entwickeln in einem hohen Prozentsatz eine symptomatische fokale Epilepsie, häufig auch einen Status epilepticus. Die in der Literatur berichtete Mortalität beträgt 30 - 50 %. Das EEG ist ferner wegweisend bezüglich der Identifizierung eines fokalen oder komplex-fokalen Status epilepticus infolge des Insultes. Prospektive randomisierte Studien über den Nutzen einer antikonvulsiven Therapie bei Risikopatienten hinsichtlich des Auftretens von Frühanfällen oder der späteren Entwicklung einer Epilepsie liegen nicht vor. Trotzdem ist in bestimmten Situationen ein frühzeitiger Einsatz von Antikonvulsiva gerechtfertigt.

Abstract

Cerebrovascular diseases are the main cause of symptomatic partial epilepsy in elderly patients. In the first five years, about 10 % of stroke patients suffer at least one epileptic seizure. In approximately half of these patients seizures occur during the first two weeks following the acute insult (early seizures). Particularly after late onset seizures the risk of epilepsy is increased. Stroke subtype, localisation, severity, preserved cortical islands within the infarction, cortical involvement and amount of cisternal blood in patients with subarachnoid haemorrhage influence the probability of epileptic seizures or epilepsy. A high proportion of patients with periodic lateralised epileptiform discharges (PLEDs) develop a chronic seizure disorder, and status epilepticus is common in those patients. Mortality rates of 30 - 50 % are reported in the literature. EEG is also a guide in diagnosing a non-convulsive status epilepticus due to stroke. Prospective randomised studies on the efficacy of anticonvulsant prophylaxis or treatment of early seizures are lacking. Nevertheless, early initiation of anticonvulsant therapy is justified in certain situations.

Literatur

  • 1 Hauser W A, Annegers J F, Kurland L T. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota 1935 - 1984.  Epilepsia. 1994;  34 453-468
  • 2 Pohlmann-Eden B, Cochius J. Stroke and epilepsy: critical review of the literature. Epidemiology and risk factors.  Cerebrovasc Dis. 1996;  6 332-338
  • 3 Pohlmann-Eden B, Cochius J. Stroke and epilepsy: critical review of the literature. Risk factors, pathophysiology and overlap syndromes.  Cerebrovasc Dis. 1997;  8 2-9
  • 4 Hauser W A, Annegers J F, Kurland L T. The prevalence of epilepsy in Rochester, Minnesota, 1940 - 1980.  Epilepsia. 1991;  32 429-445
  • 5 Peinemann A, Stefan H. Altersepilepsie.  Nervenarzt. 1998;  69 110-116
  • 6 Burn J, Dennis M, Bamford J. et al . Epileptic seizures after a first stroke: the Oxfordshire community stroke project.  BMJ. 1997;  315 1582-1587
  • 7 Bladin C, Alexandrov A, Bellavance A. et al . Seizures after stroke: a prospective multicenter study.  Arch Neurol. 2000;  57 1617-1622
  • 8 Lancman M E, Golimstok A, Norscini J, Granillo R. Risk factors for developing seizures after a stroke.  Epilepsia. 1993;  34 141-143
  • 9 Kilpatrick C J, Davis S M, Tress B M. et al . Epileptic seizures in acute stroke.  Arch Neurol. 1990;  47 157-160
  • 10 Giroud M, Gras P, Fayolle H. et al . Early seizures after acute stroke; a study of 1640 cases.  Epilepsia. 1994;  35 959-964
  • 11 Gupta S, Naheedy M, Elias D, Rubino F. Post-infarction seizures. A clinical study.  Stroke. 1988;  19 1477-1481
  • 12 Kilpatrick C, Davis S, Hopper J, Rossiter S. Early seizures after acute stroke, risk of late seizures.  Arch Neurol. 1992;  49 509-511
  • 13 Labovitz D L, Hauser W A, Sacco R L. Prevalence and predictors of early seizure and status epilepticus after first stroke.  Neurology. 2001;  57 200-206
  • 14 So E, Annegers J F, Hauser W A. et al . Population based study of seizure disorders after cerebral infarction.  Neurology. 1996;  46 350-355
  • 15 Reith J, Jorgensen H S, Nakayama H. et al . Seizures in akute stroke; predictors and prognostic significance.  Stroke. 1997;  28 1585-1589
  • 16 Arboix A, Garcia-Eroles L, Massons J B. et al . Predictive factors of early seizures after acute cerebrovascular disease.  Stroke. 1997;  28 1590-1594
  • 17 Arboix A, Comes E, Massons J. et al . Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease.  Neurology. 1996;  47 1429-1435
  • 18 Reith J, Jørgensen H S, Nakayama H. et al . Early seizures do not worsen rehabilitation outcome. The Copenhagen stroke study.  Eur J Neurol. 1996;  3 93
  • 19 Berger A R, Lipton R B, Lesser M L. et al . Early seizures following intracerebral hemorrhage: implications for therapy.  Neurology. 1988;  38 1363-1365
  • 20 Faught E, Peters D, Bartolucci A. et al . Seizures after primary intracerebral hemorrhage.  Neurology. 1989;  39 1089-1093
  • 21 Sung C Y, Chu N S. Epileptic seizures in intracerebral hemorrhage.  J Neurol Neurosurg Psychiatry. 1989;  52 1273-1276
  • 22 Hasan D, Schonk R SM, Avezaat C JJ. et al . Epileptic seizures after subarachnoid hemorrhage.  Ann Neurol. 1993;  33 286-291
  • 23 Rhoney D H, Pharm D, Tipps L B. et al . Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage.  Neurology. 2000;  55 258-265
  • 24 Butzkueven H, Evans A H, Pitman A. et al . Onset seizures independently predict poor outcome after subarachnoid hemorrhage.  Neurology. 2000;  55 1315-1320
  • 25 Viitanen M, Eriksson S, Asplund K. Risk of recurrent stroke, myocardial infarction and epilepsy during long term follow up after stroke.  Eur Neurol. 1988;  28 227-231
  • 26 Hauser W A, Ramirez-Lassepas H, Rosenstein R. Risk for seizures and epilepsy following cerebrovascular insults.  Epilepsia. 1984;  25 666
  • 27 Bamford J, Sandercock P, Warlow C, Gray M. Why are patients with acute stroke admitted to hospital?.  BMJ. 1986;  292 1369-1372
  • 28 Paolucci S, Silvestri G, Lubich S. et al . Poststroke late seizures and their role in rehabilitation of inpatients.  Epilepsia. 1997;  38 266-270
  • 29 Berges S, Moulin T, Berger E. et al . Seizures and epilepsy following stroke: Recurrence factors.  Eur Neurol. 2000;  43 3-8
  • 30 Sung C Y, Chu N S. Epileptic seizures in thrombotic stroke.  J Neurol. 1990;  237 166-170
  • 31 Kotila M, Waltimo O. Epilepsy after stroke.  Epilepsia. 1992;  33 495-498
  • 32 Dhanuka A K, Misra U K, Kalita J. Seizures after stroke: a prospective clinical study.  Neurol India. 2001;  49 33-36
  • 33 Kase C S, Wolf P A, Chodosh E H. et al . Prevalence of silent stroke in patients with initial stroke: the Framingham study.  Stroke. 1989;  20 850-852
  • 34 DeLorenzo R J, Hauser W A, Towne A R. et al . A prospective population based epidemiologic study of status epilepticus in Richmond, Virginia.  Neurology. 1996;  46 1029-1035
  • 35 Knake S, Rosenow F, Vescovi M. et al . Incidence of status epilepticus in adults in Germany: a prospective, population-based study.  Epilepsia. 2001;  42 714-718
  • 36 Delanty N, French J A, Labar D R. et al . Status epilepticus arising de novo in hospitalised patients: an analysis of 41 patients.  Seizure. 2001;  10 116-119
  • 37 Velioglu S K, Özmenoglu M, Boz C. et al . Status epilepticus after stroke.  Stroke. 2001;  32 1169-1172
  • 38 Rumbach L, Sablot D, Berger E. et al . Status epilepticus in stroke: report on a hospital-based stroke cohort.  Neurology. 2000;  54 350-354
  • 39 Dirnagl U, Iadecola C, Moskowitz M A. Pathobiology of ischaemic stroke: an integrated view.  Trends Neurosci. 1999;  22 391-397
  • 40 Bullock R, Zauner A, Woodward J, Young H F. Massive persistent release of excitatory amino acids following human occlusive stroke.  Stroke. 1995;  26 2187-2189
  • 41 Croucher M J, Bradford H F. NMDA receptor blockade inhibits glutamate-induced kindling of the rat amygdala.  Brain Res. 1990;  506 349-352
  • 42 Sun D A, Sombati S, DeLorenzo R J. Glutamate injury - induced epileptogenesis in hippocampal neurons. An in vitro model of stroke-induced epilepsy.  Stroke. 2001;  32 2344-2350
  • 43 Fernandez-Bouzas A, Harmony T, Fernandez T. et al . Sources of abnormal EEG activity in brain infarctions.  Clin Electroencephalogr. 2000;  31 165-169
  • 44 Schaul N, Gloor P, Gotman J. The EEG in deep midline lesions.  Neurology. 1981;  31 157-167
  • 45 Baykan B, Kinay D, Gökyigit A, Gürses C. Periodic lateralized epileptiform discharges: association with seizures.  Seizure. 2000;  9 402-406
  • 46 Chatrian G E, Shaw C M, Leffmann H. The significance of periodic lateralized epileptiform discharges in EEG: An electrographic clinical and pathological study.  Electroencephalogr Clin Neurophysiol. 1964;  17 177-193
  • 47 Walsh J M, Brenner R P. Periodic lateralized epileptiform discharges: long-term outcome in adults.  Epilepsia. 1987;  28 533-536
  • 48 Pohlmann-Eden B, Hoch D B, Cochius J I, Chiappa K H. Periodic lateralized epileptiform discharges: A critical review.  J Clin Neurophysiol. 1996;  13 519-530
  • 49 Snodgrass S M, Tsuburaya K, Ajmone-Marsan C. Clinical significance of periodic lateralized epileptiform discharges: relationship with status epilepticus.  J Clin Neurophysiol. 1989;  6 159-172
  • 50 Brenner R P, Schaul N. Periodic EEG patterns: Classification, clinical correlation and pathophysiology.  J Clin Neurophysiol. 1990;  7 249-267
  • 51 Schwartz M S, Prior P F, Scott P F. The occurrence and evolution in the EEG of lateralized periodic phenomenon.  Brain. 1973;  96 613-622
  • 52 Westmoreland B F, Klass D W, Sharbrough F W. Chronic periodic lateralized epileptiform discharges.  Arch Neurol. 1986;  43 494-496
  • 53 Ryglewicz D, Barnska-Gieruszczak M, Niedzielska K, Kyrst-Widzgowski T. EEG and CT findings in poststroke epilepsy.  Acta Neurol Scand. 1990;  81 488-490
  • 54 Niedzielska K, Baranska-Gieruszczak M, Kuran W. et al . EEG value in cases of epileptic seizures in early phase of stroke.  Neurol Neurochir Pol. 2001;  35 595-603
  • 55 Pohlmann-Eden B, Hoch D, Cochius J, Chiappa K H. The significance of subclinical epileptiform processes after acute stroke: The results of a preliminary prospective study.  Epilepsia. 1995;  36 88
  • 56 Holmes G L. The electroencephalogram as a predictor of seizures following cerebral infarction.  Clin Electroencephalogr. 1980;  11 83-86
  • 57 Lansberg M, O'Brien M, Norbash A. et al . MRI abnormalities associated with partial status epilepticus.  Neurology. 1999;  52 1021-1027
  • 58 Lesser R P, Lüders H, Dinner D S, Morris H H. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients.  Epilepsia. 1985;  26 622-630
  • 59 Pohlmann-Eden B, Fatar M, Hennerici M. The Preserved Cortical Island Sign is hihly predictive of postischemic seizures.  Cerebrovasc Dis. 2001;  12 282
  • 60 Awada A, Omojola M F, Obeid T. Late epileptic seizures after cerebral infarction.  Acta Neurol Scand. 1999;  99 265-268
  • 61 Daniele O, Caravaglios G. Stroke related seizures and the role of cortical and subcortical structures.  J Epilepsy. 1996;  9 184-188
  • 62 Schreiner A, Pohlmann-Eden B, Schwartz A, Hennerici M. Epileptic seizures in subcortical vascular encephalopathy.  J Neur Sci. 1995;  130 171-177
  • 63 Bentes C, Pimentel J, Ferro J M. Epileptic seizures following subcortical infarcts.  Cerebrovasc Dis. 2001;  12 331-334
  • 64 Giroud M, Dumas R. Role of associated cortical lesions in motor partial seizures and lenticulostriate infarcts.  Epilepsia. 1995;  36 465-470
  • 65 Cocito L, Loeb B. Focal epilepsy as a possible sign of transient subclinical ischemia.  Eur Neurol. 1989;  29 339-344
  • 66 Willmore L J, Sypert G W, Munson J B, Hurd R W. Chronic focal epileptiform discharges induced by injection of iron into rat and cat cortex.  Science. 1978;  200 1501-1503
  • 67 Olafsson E, Gudmundsson G, Hauser W A. Risk of epilepsy in long-term survivors of surgery for subarachnoidal hemorrhage: a populationbased study in Iceland.  Epilepsia. 2000;  41 1201-1205
  • 68 Nagpal R D. Dural sinus and cerebral venous thrombosis.  Neurosurg Rev. 1983;  6 155-160
  • 69 Sundt T, Sharbrough F, Piepgras D. et al . Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy.  Mayo Clin Proc. 1981;  56 533-543
  • 70 Ho D SW, Wang Y, Chui M. et al . Epileptic seizures attributed to cerebral hyperperfusion after percutaneous transluminal angioplasty and stenting of the internal carotid artery.  Cerebrovasc Dis. 2000;  10 374-379
  • 71 Macfarlane R, Moskowitz M, Sakas D. et al . The role of neuroeffector mechanisms in cerebral hyperperfusion syndromes.  J Neurosurg. 1991;  75 845-855
  • 72 Pomposelli F, Lamparello P, Riles T. et al . Intracranial hemorrhage after carotid endarterectomy.  J Vasc Surg. 1988;  7 248-255
  • 73 Baptista M V, Maeder P, Dewarrat A, Bogouslavsky J. Conflicting images: Case reports.  Lancet. 1998;  35 414
  • 74 Schroeder T, Sillesen H, Sorensen O, Engell H C. Cerebral hyperperfusion following carotid endarterectomy.  J Neurosurg. 1987;  6 824-829
  • 75 Gilad R, Lampl Y, Eschel Y, Sadeh M. Antiepileptic treatment in patients with early postischemic stroke seizures: a retrospective study.  Cerebrovasc Dis. 2001;  12 39-43
  • 76 Broderick J, Adams H, Barsan W. et al . Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for the healthcare professionals from a special writing group of the Stroke Council, American Heart Association.  Stroke. 1999;  30 905-915
  • 77 Mayberg M, Batjer H, Dacey R. et al . Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for the healthcare professionals from a special writing group of the Stroke Council, American Heart Association.  Circulation. 1994;  90 2592-2605
  • 78 Schmidt D, Arroyo S, Baulac M. et al . Recommendations on the clinical use of oxcarbazepine in the treatment of epilepsy: a consensus view.  Acta Neurol Scand. 2001;  104 167-170
  • 79 Brodie M, Overstall P, Giorgi L. for the UK Lamotrigine Elderly Study Group . Multicenter, double blind, randomised comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy.  Epilepsy Res. 1999;  37 81-87
  • 80 Martin R, Meador K, Turrentine L. et al . Comparative cognitive effects of Carbamazepine and Gabapentin in healthy senior adults.  Epilepsia. 2001;  42 764-771
  • 81 Yang Y, Li Q, Shuaib A. Enhanced neuroprotection and reduced hemorrhagic incidence in focal cerebral ischemia of rat by low dose combination therapy of urokinase and topiramate.  Neuropharmacology. 2000;  39 881-888
  • 82 Yang Y, Shuaib A, Li Q, Siddiqui M M. Neuroprotection by delayed administration of topiramate in a rat model of middle cerebral artery embolization.  Brain Res. 1998;  804 169-176

Dr. med. L. Weitemeyer

Klinik für Neurologie · Universitätsklinikum Münster

Albert-Schweitzer-Straße 33

48129 Münster

Email: weiteml@uni-muenster.de

    >