From the Guidelines
Post infarct seizure management should prioritize prompt treatment with short-acting medications, such as lorazepam IV, for seizures that are not self-limiting, while avoiding prophylactic use of anticonvulsant medications due to potential harm and negative effects on neural recovery 1.
Key Considerations
- New-onset seizures in patients with acute stroke should be treated with short-acting medications, such as lorazepam IV, if they are not self-limiting 1.
- A single, self-limiting seizure occurring at the onset or within 24 hours after an ischemic stroke should not be treated with long-term anticonvulsant medications 1.
- Patients with immediate post-stroke seizures should be monitored for recurrent seizure activity and treated as per treatment recommendations for seizures in other neurological conditions 1.
- Prophylactic use of anticonvulsant medications in patients with ischemic stroke is not recommended due to lack of evidence and potential harm 1.
Management Approach
- First-line treatment involves intravenous benzodiazepines, such as lorazepam (4 mg IV) or diazepam (10 mg IV), to terminate the seizure.
- Maintenance antiepileptic drugs (AEDs) with minimal cardiac effects, such as levetiracetam or lamotrigine, may be considered for patients with recurrent seizures.
- Concurrent management should include cardiac stabilization, maintaining adequate oxygenation, and correcting any electrolyte imbalances.
- Continuous EEG monitoring is recommended for at least 24-48 hours to detect subclinical seizures.
- The underlying cause of the seizure must be investigated, including possible extension of the infarct, cerebral embolism, or drug effects.
From the Research
Management of Post Infarct Seizure
The management of post infarct seizure, particularly in the context of myocardial infarction, involves understanding the risk factors and the appropriate treatment strategies.
- Risk Factors:
- The presence of large cortical infarcts is a significant risk factor for seizures after a stroke 2, 3, 4.
- Cortical distribution of ischemic infarction is independently associated with seizures 3.
- Other medical problems known to lower the seizure threshold, such as renal failure, can also increase the risk of seizures 4.
- Treatment Strategies:
- Antiepileptic drugs (AEDs) may be used to manage seizures, with valproate and levetiracetam showing potential in transitioning patients from epileptiform states to non-epileptiform states, especially in those with continuous EEG background activity 5.
- The decision to use prophylactic treatment with AEDs in stroke patients should be based on identified risk factors and the type of seizure (early-onset or late-onset) 2.
- Seizure Control: