TY - JOUR
T1 - Long-term risk of seizures and epilepsy in patients with posterior reversible encephalopathy syndrome
AU - Datar, Sudhir
AU - Singh, Tarun
AU - Rabinstein, Alejandro A.
AU - Fugate, Jennifer E.
AU - Hocker, Sara
N1 - Publisher Copyright:
© Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Summary Objective Seizures are common in patients with posterior reversible encephalopathy syndrome (PRES), which is reported in up to 70% of cases, and antiepileptic drugs (AEDs) are commonly prescribed. There is a paucity of data regarding the risk of subsequent seizures following resolution of PRES, and therefore the optimal duration of treatment with AEDs is currently unknown. The objective of this study was to identify the frequency of recurrent seizures and epilepsy following recovery from PRES. Methods We performed a retrospective review of consecutive adults diagnosed with PRES between 2000 and 2010. Results One hundred twenty-seven patients, median age 53 years (interquartile range [IQR] 37-64), were included in the analysis. The most common causes of PRES were hypertension (72%) and immunosuppression (20%). Renal failure was present in 47%. Eighty-four patients (66%) had seizures at presentation (39 focal, 45 generalized), and 13 (15%) of them presented with status epilepticus. Median duration of follow-up was 3.2 years (IQR 4 months to 6.9 years). Patients with seizures were treated with AEDs for a median of 3 months (IQR 2-7). Fifteen patients (12%) had provoked seizures during the follow-up period; in eight (53%) patients seizures were caused by recurrent PRES. Only three patients had subsequent unprovoked seizures, one of whom was considered to have developed epilepsy. Significance We conclude that unprovoked seizures and epilepsy are uncommon in patients who have recovered from PRES. Discontinuation of AEDs following resolution of PRES should be considered, provided there is adequate control of risk factors, and absence of factors that could substantially lower the seizure threshold.
AB - Summary Objective Seizures are common in patients with posterior reversible encephalopathy syndrome (PRES), which is reported in up to 70% of cases, and antiepileptic drugs (AEDs) are commonly prescribed. There is a paucity of data regarding the risk of subsequent seizures following resolution of PRES, and therefore the optimal duration of treatment with AEDs is currently unknown. The objective of this study was to identify the frequency of recurrent seizures and epilepsy following recovery from PRES. Methods We performed a retrospective review of consecutive adults diagnosed with PRES between 2000 and 2010. Results One hundred twenty-seven patients, median age 53 years (interquartile range [IQR] 37-64), were included in the analysis. The most common causes of PRES were hypertension (72%) and immunosuppression (20%). Renal failure was present in 47%. Eighty-four patients (66%) had seizures at presentation (39 focal, 45 generalized), and 13 (15%) of them presented with status epilepticus. Median duration of follow-up was 3.2 years (IQR 4 months to 6.9 years). Patients with seizures were treated with AEDs for a median of 3 months (IQR 2-7). Fifteen patients (12%) had provoked seizures during the follow-up period; in eight (53%) patients seizures were caused by recurrent PRES. Only three patients had subsequent unprovoked seizures, one of whom was considered to have developed epilepsy. Significance We conclude that unprovoked seizures and epilepsy are uncommon in patients who have recovered from PRES. Discontinuation of AEDs following resolution of PRES should be considered, provided there is adequate control of risk factors, and absence of factors that could substantially lower the seizure threshold.
KW - Hypertensive emergency
KW - Hypertensive encephalopathy
KW - Posterior reversible encephalopathy syndrome
KW - Seizures
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U2 - 10.1111/epi.12933
DO - 10.1111/epi.12933
M3 - Review article
C2 - 25690439
AN - SCOPUS:84927570380
SN - 0013-9580
VL - 56
SP - 564
EP - 568
JO - Epilepsia
JF - Epilepsia
IS - 4
ER -