Características das crises epilépticas após acidente vascular cerebral isquêmico

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.

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.