Características das crises epilépticas após acidente vascular cerebral isquêmico

Fukujima, Márcia Maiumi; Cardeal, José Osmar

doi:10.1590/S0004-282X1997000500010

Resumos

Os infartos cerebrais constituem uma das mais importantes causas de epilepsia de início tardio. Foram estudados 35 pacientes que apresentaram crises epiléptica com início 24 horas após a instalação do acidente vascular cerebral isquêmico (AVCI) e que tiveram pelo menos 1 recorrência da crise, a fim de definir as principais características dessas crises e correlacioná-las aos principais achados clínicos e laboratoriais. O tempo entre a instalação do AVCI e a primeira crise foi de 3 a 1650 dias, com predomínio (89%) de crises de instalação tardia (>14 dias); houve um pico de freqüência no período de 6 a 12 meses após a instalação do AVC. Crises parciais foram mais freqüentes (31/35) do que crises primariamente generalizadas, e estado de mal epiléptico só ocorreu em 3 casos. A maioria (30/35) apresentou crises pouco freqüentes (< 1 crise/mês). Não houve associação entre tipo de crise e intervalo de tempo entre ela e a instalação do AVCI, nem com a freqüência. A alteração eletrencefalográfica mais freqüente foi alentecimento focai da atividade elétrica cerebral. Todos os pacientes obtiveram controle das crises com monoterapia.

infarto cerebral; crise epiléptica; epilepsia tardia

Cerebral infarctions are one of the most important causes of late onset epilepsy. We have studied 35 patients who presented epileptic seizures after ischemic stroke. All of them had the first seizure at least 24 hours after the stroke, and they had at least one recurrence of seizure. The objective was to determine the main characteristics of these seizures and to correlate them to clinical and laboratorial findings. The interval between the stroke and the first seizure was 3 to 1650 days. Late onset seizures (>14 days) were present in 89%, they occurred predominantly 6 to 12 months after stroke. Partial seizures (31/35) were more frequent than generalized ones. Status epilepticus occurred in only 3 cases. Most of the patients (30/35) had occasional seizures (<, 1 seizure monthly). There were no association between seizure type and the time interval between the stroke and the first seizure, neither with the seizure frequency. The most frequent EEG finding was focal slowing oi cerebral activity. Pharmacological control was easily obtained. No patient needed more than one drug for seizure control.

cerebral infarction; late onset epilepsy; epileptic seizure

Características das crises epilépticas após acidente vascular cerebral isquêmico

Characteristics of epileptic seizures after ischemic stroke

Márcia Maiumi Fukujima^I; José Osmar Cardeal^II

^INeurologista na EPM - UNIFESP

^IIProfessor Adjunto da Disciplina de Neurologia da EPM - UNIFESP

RESUMO

Os infartos cerebrais constituem uma das mais importantes causas de epilepsia de início tardio. Foram estudados 35 pacientes que apresentaram crises epiléptica com início 24 horas após a instalação do acidente vascular cerebral isquêmico (AVCI) e que tiveram pelo menos 1 recorrência da crise, a fim de definir as principais características dessas crises e correlacioná-las aos principais achados clínicos e laboratoriais. O tempo entre a instalação do AVCI e a primeira crise foi de 3 a 1650 dias, com predomínio (89%) de crises de instalação tardia (>14 dias); houve um pico de freqüência no período de 6 a 12 meses após a instalação do AVC. Crises parciais foram mais freqüentes (31/35) do que crises primariamente generalizadas, e estado de mal epiléptico só ocorreu em 3 casos. A maioria (30/35) apresentou crises pouco freqüentes (< 1 crise/mês). Não houve associação entre tipo de crise e intervalo de tempo entre ela e a instalação do AVCI, nem com a freqüência. A alteração eletrencefalográfica mais freqüente foi alentecimento focai da atividade elétrica cerebral. Todos os pacientes obtiveram controle das crises com monoterapia.

Palavras-chave: infarto cerebral, crise epiléptica, epilepsia tardia.

ABSTRACT

Cerebral infarctions are one of the most important causes of late onset epilepsy. We have studied 35 patients who presented epileptic seizures after ischemic stroke. All of them had the first seizure at least 24 hours after the stroke, and they had at least one recurrence of seizure. The objective was to determine the main characteristics of these seizures and to correlate them to clinical and laboratorial findings. The interval between the stroke and the first seizure was 3 to 1650 days. Late onset seizures (>14 days) were present in 89%, they occurred predominantly 6 to 12 months after stroke. Partial seizures (31/35) were more frequent than generalized ones. Status epilepticus occurred in only 3 cases. Most of the patients (30/35) had occasional seizures (<, 1 seizure monthly). There were no association between seizure type and the time interval between the stroke and the first seizure, neither with the seizure frequency. The most frequent EEG finding was focal slowing oi cerebral activity. Pharmacological control was easily obtained. No patient needed more than one drug for seizure control.

Key wors: cerebral infarction, late onset epilepsy, epileptic seizure.

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Aceite: 7-julho-1997.

Estudo realizado no Setor de Doenças Neurovasculares da Disciplina de Neurologia da Escola Paulista de Medicina (EPM) da Universidade Federal de São Paulo (UNIFESP), baseado na Tese de Mestrado "Crises epilépticas após acidente vascular cerebral por infarto cerebral: estudo de 35 pacientes"^21,22.

Dra. Marcia Maiumi Fukujima - Universidade Federal de São Paulo, Disciplina de Neurologia - Rua Botucatu 740 - 04023-900 São Paulo SP - Brasil. FAX 011 575 5240. E-mail: Maiumi@sti.com.br ou maiumi@sun-nepi.epm.br

1. Annegers JF, Hauser WA, Lee JR, Rocca WA. Incidence of acute seizures in Rochester, Minnesota 1935-1984. Epilepsia 1995;36:327-333.
2. Barolin GS. The cerebrovascular epilepsies. Eletrencephalogr Clin Neurophysiol 1982;35 (Suppl.):287- 295.
3. Barolin GS, Scherz A. The cerebrovascular epilepsies. Eletrencephalogr Clin Neurophysiol 1974;27:347-352.
4. Barry E, Hauser WA. Status epilepticus: the interaction of epilepsy and acute brain disease. Neurology 1993;43:1473-1478.
5. Blandin CF, Johnston PJ, Norris JW. Stroke Research Unit, University of Toronto, Canada for The Seizures after Stroke Study Group (Canada, Australia, Israel, Italy). Stroke 1993;24:49.
6. Browne TR, Feldman RG. Epilepsy: an overview. In: Browne TR, Feldman RG. Epilepsy: diagnosis and management. Boston: Little, Brown, 1983:1-10.
7. Celesia GG. Modern concepts of status epilepticus. JAMA 1971;235:1571-1574.
8. Chusid JG, Kopeloff LM. Epileptogenic effects of pure metals implanted in motor cortex of monkeys. J Appl Physiol 1962;17:696-700.
9. Cocito L, Favale E, Reni L. Epileptic seizures in cerebral arterial occlusive disease. Stroke 1982;13:189-195.
10. Cocito L, Favale E, Reni L. The frequency, characteristics and prognosis of epileptic seizure at the onset of stroke. J Neurol Neurosurg Psychiatry 1989;52:292.
11. Commission Of Classification And Terminology Of The International League Against Epilepsy. Proposal for revised clinical and eletroencephalografic classification of epileptic seizures. Epilepsia 1981-,22:489- 501.
12. Commission of Classification and Terminology of The International League Against Epilepsy. Proposal for revised classification on epilepsies and epileptic syndromes. Epilepsia 1989;30:389-399.
13. Dams AM, Fuglsang-Frederickson A, Svarre-Olsen U, Dam M. Late onset epilepsy, etiologies, types of seizure and value of clinical investigation, EEG and CT scan. Epilepsia 1986;26:227-231.
14. DeReuck J, Krahel N, Sieben G, Orban L, Decoster W, VanderEcken H. Epilepsy in patients with cerebral infarcts. J Neurol 1980;224:101-109.
15. Ettinger AB. Structural causes of epilepsy: tumors, cysts, stroke, and vascular malformations. Neurol Clin 1994;12:41-56.
16. Famarier G, Iemolo F. Etude longitudinale des epilepsies survenant chez l'adulte. Rev EEG Neurophisiol 1981 ;11:531-536.
17. Fentz V. Epileptiske anfaldsfaenomener hos patienter med apoplexia cerebri. Nord Med 1971;86:1023-1025.
18. Fish DR, Miller DR, Roberts RC, Blackie JD, Gilliatt RW. The natural history of late-onset epilepsy secondary to vascular disease. Acta Neurol Scand 1989;80:524-526.
19. Forsgren L, Bucht G Ericksson S.Bergmark L. Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia 1996;37:224-229.
20. Fuerstein J, Weber M, Kurtz D, Rohmer F. Etude statistique des crises épileptiques apparaisant apres l'âge de 60 ans. Semin Hõp Paris 1970;46:3125-3128.
21. Fukujima MM. Crises epilépticas após acidente vascular cerebral por infarto cerebral: Estudo de 35 pacientes. Tese de Mestrado, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 1994.
22. Fukujima MM. Epileptic seizures after ischemic stroke: study of 35 patients. (Abstract). Arq Neuropsiquiatr 1996;54:714.
23. Fukujima MM, Cardeal JO, Lima JGC. Estudo de fatores clínicos preditivos para crises epilépticas após acidente vascular cerebral isquêmico. Arq Neuropsiquiatr 1996;54:207-211.
24. Fukujima MM, Cardeal JO. Exames subsidiários preditivos de crises epilépticas após acidente vascular cerebral isquêmico. Arq Neuropsiquiatr 1997;55:39-45.
25. Gupta SR, Naheedy MH, Elias D, Rubino FA. Postinfarction seizures: a clinical study. Stroke 1988;19:1477-1481.
26. Hauser WA, Kurland LT. The epidemiology of epilepsy in Rochester, Minnesota, 1953 though 1967. Epilepsia 1975;16:1-66.
27. Heiss WD, Hayakama T, Waltz AG. Cortical neuronal function during ischemia. Arch Neurol 1976;33:813-820.
28. Janz D, Masuhr KF. Epilepsia tarda: a clinical, EEG and neurorradiological study (taking in consideration cranial computerized tomography). Epilepsia 1978;19: 110.
29. Lesser R, Luders H, Dinner DS, Morris HH. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985;26:622-630.
30. Levitt P, Wilson WP, Wildins RH. The effects of subarachnoid blood on the electrocorticogram of the cat. J Neurosurg 1971;35:185-191.
31. Lo YK, Yiu CH, Hu HH, Su MS, Laeuchli SC. Frequency and characteristics of early seizures in Chinese acute stroke. Acta Neurol Scand 1994;90:83-85.
32. Louis S, McDowell F. Epileptic seizures in nonembolic cerebral infarction. Arch Neurol 1967;17:414-418.
33. Luhdorf F, Jensen LK, Plesner A.Etiology of seizures in the eldery. Epilepsia 1986;27:458-463.
34. Marosi M, Luef G, Schett P, Graf M, Sailer U, Bauer G. The effects of brain lesions on the course os chronic epilepsies. Epilepsy Res 1994;19:63-69.
35. Merlis JK. Epilepsy of late onset. In Magnus O, Haas AML. The epilepsies. New York: Elsevier, 1974:264-270.
36. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL. The Harvard cooperative stroke registry: a prospective registry. Neurology 1978;28: 754-762.
37. Moskowitz E, Lightbody FEH, Freitag NS. Long-term follow-up of the poststroke patient. Arch Phys Med Rehab 1972;53:167-172.
38. Olsen TS, Hogenhaven H, Thage O. Epilepsy after stroke. Neurology 1987;37:1209-1211.
39. Penfield W, Jasper H. Epilepsy and functional anatomy of the human brain. Boston: Little, Brown & Co., 1954.
40. Richardson EP, Dodge PR. Epilepsy in cerebral vascular disease: a study of the incidence and nature of 104 consecutive proven cases of cerebral infarction and hemorrhage. Epilepsia 1954;3:49-74.
41. Schold C, Yarnell PR, Earnest MP. Origin of seizures in eldery patients. JAMA 1977;238:1177-1178.
42. Shinton RA, Gill JS, Melnick SC, Gupta AK, Beevers DG. The frequency, characteristics and prognosis of epileptic seizure at the onset of stroke. J Neurol Neurosurg Psychiatry 1988;51:273-276.
43. Siegel S. Estadistica no parametrica. México: Trillas, 1975:346.
44. So EL, Annegers JF, Hauser WA, O'Brien PC, Whisnant JP. Population-based study of seizure disorders after cerebral infarction. Neurology 1996;46:350-355.
45. Sung CY, Chu NS. Epileptic seizures in thrombotic stroke. J Neurol 1990;237:166-170.
46. Vasconcelos D, Lombardo L. Crisis epilépticas del adulto: estúdio prospective) de 65 casos. Gac Med Mex 1983; 119:23-27.
47. Vercelletto P, Delobel-Cozan R. Étude des facteurs étiologiques et prognostiques dans les epilepsies debutant après 60 ans. Semin HôpParis 1970;46:3133-3137.
48. Viitaren M, Erickson S, Asplund K. Risk of recurrent stroke, myocardial infarction and epilepsy during long-term follow-up after stroke. Eur Neurol 1988;28:227-231.
49. Whisnant JP, Basford JR, Bernstein EF, et al. Special report from the National Institute of Neurological Disorders and Stroke. Classification of Cerebrovascular Disease III. Stroke 1990;21:637-676.
50. White PT, Bailey AA, Bickford RG. Epileptic disorders in the aged. Neurology 1953;3:674-679.
51. Willmore LJ, Herd RW, Sypert GW. Epileptiform activity initiated by pial iontophoresis of ferrous and ferric chlorid on rat cerebral cortex. Brain Res 1978;152:406-410.
52. Winckler TCD. Crises epilépticas de início tardio: análise de 100 casos. Tese de Mestrado, Escola Paulista de Medicina. São Paulo, 1988.
53. Woodcock S, Cosgrove JBR. Epilepsy after the age of 50: a five-year follow-up study. Neurology 1964;14:34-40.

Datas de Publicação

Publicação nesta coleção
21 Out 2010
Data do Fascículo
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Annegers JF, Hauser WA, Lee JR, Rocca WA. Incidence of acute seizures in Rochester, Minnesota 1935-1984. Epilepsia 1995;36:327-333.

[2] 2. Barolin GS. The cerebrovascular epilepsies. Eletrencephalogr Clin Neurophysiol 1982;35 (Suppl.):287- 295.

[3] 3. Barolin GS, Scherz A. The cerebrovascular epilepsies. Eletrencephalogr Clin Neurophysiol 1974;27:347-352.

[4] 4. Barry E, Hauser WA. Status epilepticus: the interaction of epilepsy and acute brain disease. Neurology 1993;43:1473-1478.

[5] 5. Blandin CF, Johnston PJ, Norris JW. Stroke Research Unit, University of Toronto, Canada for The Seizures after Stroke Study Group (Canada, Australia, Israel, Italy). Stroke 1993;24:49.

[6] 6. Browne TR, Feldman RG. Epilepsy: an overview. In: Browne TR, Feldman RG. Epilepsy: diagnosis and management. Boston: Little, Brown, 1983:1-10.

[7] 7. Celesia GG. Modern concepts of status epilepticus. JAMA 1971;235:1571-1574.

[8] 8. Chusid JG, Kopeloff LM. Epileptogenic effects of pure metals implanted in motor cortex of monkeys. J Appl Physiol 1962;17:696-700.

[9] 9. Cocito L, Favale E, Reni L. Epileptic seizures in cerebral arterial occlusive disease. Stroke 1982;13:189-195.

[10] 10. Cocito L, Favale E, Reni L. The frequency, characteristics and prognosis of epileptic seizure at the onset of stroke. J Neurol Neurosurg Psychiatry 1989;52:292.

[11] 11. Commission Of Classification And Terminology Of The International League Against Epilepsy. Proposal for revised clinical and eletroencephalografic classification of epileptic seizures. Epilepsia 1981-,22:489- 501.

[12] 12. Commission of Classification and Terminology of The International League Against Epilepsy. Proposal for revised classification on epilepsies and epileptic syndromes. Epilepsia 1989;30:389-399.

[13] 13. Dams AM, Fuglsang-Frederickson A, Svarre-Olsen U, Dam M. Late onset epilepsy, etiologies, types of seizure and value of clinical investigation, EEG and CT scan. Epilepsia 1986;26:227-231.

[14] 14. DeReuck J, Krahel N, Sieben G, Orban L, Decoster W, VanderEcken H. Epilepsy in patients with cerebral infarcts. J Neurol 1980;224:101-109.

[15] 15. Ettinger AB. Structural causes of epilepsy: tumors, cysts, stroke, and vascular malformations. Neurol Clin 1994;12:41-56.

[16] 16. Famarier G, Iemolo F. Etude longitudinale des epilepsies survenant chez l'adulte. Rev EEG Neurophisiol 1981 ;11:531-536.

[17] 17. Fentz V. Epileptiske anfaldsfaenomener hos patienter med apoplexia cerebri. Nord Med 1971;86:1023-1025.

[18] 18. Fish DR, Miller DR, Roberts RC, Blackie JD, Gilliatt RW. The natural history of late-onset epilepsy secondary to vascular disease. Acta Neurol Scand 1989;80:524-526.

[19] 19. Forsgren L, Bucht G Ericksson S.Bergmark L. Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia 1996;37:224-229.

[20] 20. Fuerstein J, Weber M, Kurtz D, Rohmer F. Etude statistique des crises épileptiques apparaisant apres l'âge de 60 ans. Semin Hõp Paris 1970;46:3125-3128.

[21] 21. Fukujima MM. Crises epilépticas após acidente vascular cerebral por infarto cerebral: Estudo de 35 pacientes. Tese de Mestrado, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 1994.

[22] 22. Fukujima MM. Epileptic seizures after ischemic stroke: study of 35 patients. (Abstract). Arq Neuropsiquiatr 1996;54:714.

[23] 23. Fukujima MM, Cardeal JO, Lima JGC. Estudo de fatores clínicos preditivos para crises epilépticas após acidente vascular cerebral isquêmico. Arq Neuropsiquiatr 1996;54:207-211.

[24] 24. Fukujima MM, Cardeal JO. Exames subsidiários preditivos de crises epilépticas após acidente vascular cerebral isquêmico. Arq Neuropsiquiatr 1997;55:39-45.

[25] 25. Gupta SR, Naheedy MH, Elias D, Rubino FA. Postinfarction seizures: a clinical study. Stroke 1988;19:1477-1481.

[26] 26. Hauser WA, Kurland LT. The epidemiology of epilepsy in Rochester, Minnesota, 1953 though 1967. Epilepsia 1975;16:1-66.

[27] 27. Heiss WD, Hayakama T, Waltz AG. Cortical neuronal function during ischemia. Arch Neurol 1976;33:813-820.

[28] 28. Janz D, Masuhr KF. Epilepsia tarda: a clinical, EEG and neurorradiological study (taking in consideration cranial computerized tomography). Epilepsia 1978;19: 110.

[29] 29. Lesser R, Luders H, Dinner DS, Morris HH. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985;26:622-630.

[30] 30. Levitt P, Wilson WP, Wildins RH. The effects of subarachnoid blood on the electrocorticogram of the cat. J Neurosurg 1971;35:185-191.

[31] 31. Lo YK, Yiu CH, Hu HH, Su MS, Laeuchli SC. Frequency and characteristics of early seizures in Chinese acute stroke. Acta Neurol Scand 1994;90:83-85.

[32] 32. Louis S, McDowell F. Epileptic seizures in nonembolic cerebral infarction. Arch Neurol 1967;17:414-418.

[33] 33. Luhdorf F, Jensen LK, Plesner A.Etiology of seizures in the eldery. Epilepsia 1986;27:458-463.

[34] 34. Marosi M, Luef G, Schett P, Graf M, Sailer U, Bauer G. The effects of brain lesions on the course os chronic epilepsies. Epilepsy Res 1994;19:63-69.

[35] 35. Merlis JK. Epilepsy of late onset. In Magnus O, Haas AML. The epilepsies. New York: Elsevier, 1974:264-270.

[36] 36. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL. The Harvard cooperative stroke registry: a prospective registry. Neurology 1978;28: 754-762.

[37] 37. Moskowitz E, Lightbody FEH, Freitag NS. Long-term follow-up of the poststroke patient. Arch Phys Med Rehab 1972;53:167-172.

[38] 38. Olsen TS, Hogenhaven H, Thage O. Epilepsy after stroke. Neurology 1987;37:1209-1211.

[39] 39. Penfield W, Jasper H. Epilepsy and functional anatomy of the human brain. Boston: Little, Brown & Co., 1954.

[40] 40. Richardson EP, Dodge PR. Epilepsy in cerebral vascular disease: a study of the incidence and nature of 104 consecutive proven cases of cerebral infarction and hemorrhage. Epilepsia 1954;3:49-74.

[41] 41. Schold C, Yarnell PR, Earnest MP. Origin of seizures in eldery patients. JAMA 1977;238:1177-1178.

[42] 42. Shinton RA, Gill JS, Melnick SC, Gupta AK, Beevers DG. The frequency, characteristics and prognosis of epileptic seizure at the onset of stroke. J Neurol Neurosurg Psychiatry 1988;51:273-276.

[43] 43. Siegel S. Estadistica no parametrica. México: Trillas, 1975:346.

[44] 44. So EL, Annegers JF, Hauser WA, O'Brien PC, Whisnant JP. Population-based study of seizure disorders after cerebral infarction. Neurology 1996;46:350-355.

[45] 45. Sung CY, Chu NS. Epileptic seizures in thrombotic stroke. J Neurol 1990;237:166-170.

[46] 46. Vasconcelos D, Lombardo L. Crisis epilépticas del adulto: estúdio prospective) de 65 casos. Gac Med Mex 1983; 119:23-27.

[47] 47. Vercelletto P, Delobel-Cozan R. Étude des facteurs étiologiques et prognostiques dans les epilepsies debutant après 60 ans. Semin HôpParis 1970;46:3133-3137.

[48] 48. Viitaren M, Erickson S, Asplund K. Risk of recurrent stroke, myocardial infarction and epilepsy during long-term follow-up after stroke. Eur Neurol 1988;28:227-231.

[49] 49. Whisnant JP, Basford JR, Bernstein EF, et al. Special report from the National Institute of Neurological Disorders and Stroke. Classification of Cerebrovascular Disease III. Stroke 1990;21:637-676.

[50] 50. White PT, Bailey AA, Bickford RG. Epileptic disorders in the aged. Neurology 1953;3:674-679.

[51] 51. Willmore LJ, Herd RW, Sypert GW. Epileptiform activity initiated by pial iontophoresis of ferrous and ferric chlorid on rat cerebral cortex. Brain Res 1978;152:406-410.

[52] 52. Winckler TCD. Crises epilépticas de início tardio: análise de 100 casos. Tese de Mestrado, Escola Paulista de Medicina. São Paulo, 1988.

[53] 53. Woodcock S, Cosgrove JBR. Epilepsy after the age of 50: a five-year follow-up study. Neurology 1964;14:34-40.