About this Research Topic

Background

Clinical acute symptomatic seizures (ASyS) account for 40% of all afebrile seizures. With an exponential increase in the use of EEG monitoring at the time of acute brain injuries (ABIs) worldwide, there has been a significant increase in the detection of ASyS, the majority of which are non-convulsive. In addition to electrographic seizures (Sz), cEEG identifies other epileptiform abnormalities (EAs) such as lateralized periodic discharges (LPDs, formerly PLEDs), lateralized rhythmic delta activity (LRDA), sporadic epileptiform discharges, etc. in approximately 30% of the recordings. The EAs are conclusively associated with an increased risk of ASyS, but their long-term significance is not well understood. Around 20% of AsyS patients suffer 30-days mortality. Additionally, 20 - 30% of ASyS patients go on to develop epilepsy. Therefore, patients with ASyS and EAs are invariably treated with ASMs to prevent recurrent ASyS. However, it is unclear how long after ASyS and EAs do the risk of Sz remains high enough to warrant ASM use. Currently, prolonged ASM treatment does not reduce the long-term risk of epilepsy development. Nonetheless, almost all patients with ASyS are discharged on ASMs, and 50-90% of them continue ASMs for 12 months or longer. In addition, the impact of ASMs on neurocognitive outcomes in this population remains unexplored.

There is a vast knowledge gap about the immediate and long-term implications of ASyS and EAs on patient outcomes, including morbidity, epilepsy development (epileptogenesis), cognition, and psychosocial metrics. ASyS are associated with increased mortality. However, almost no data and research guide the in-hospital and post-discharge ASM management after ASyS. The common practice of using ASMs in patients with acute EAs to prevent ASyS goes scientifically unchallenged. The evidence-free use of ASMs is a major concern as their impact on functional outcomes is poorly understood. Additionally, it remains unclear if clinical and electrographic ASyS exert comparable impact on patient outcomes and deserve equally aggressive management. The duration of ASMs use for secondary prophylaxis of early and late seizures needs to be balanced against their potential adverse effects and lack of anti-epileptogenesis properties.

Research in the last couple of years illustrates that acute EAs and electrographic ASyS may serve as biomarkers of epileptogenesis, and their high burden could be associated with poor functional outcomes at hospital discharge. However, this is only akin to the proverbial “scratching the surface”, and there is a dire need to “dig deeper”, because ASyS and EAs are ubiquitous in clinical practice of epilepsy, especially given the high prevalence of ABIs like traumatic brain injury, strokes, hemorrhage, etc. The last two decades have seen rapid and parallel advancements in neurocritical care and critical care epilepsy through the use of acute EEG monitoring, which has brought us to the threshold of major breakthroughs in addressing the above questions.

The goal of this Research Topic is to become the landmark step that heralds our collective understanding of management and outcomes after ASyS and EAs.

We are interested in original research articles, brief research, case reports, mini-reviews, full-length reviews, systematic reviews, perspective, opinions, hypothesis and theory generation that address following themes:

• Epidemiology of ASyS and acute EAs in various ABI and systemic insults/encephalopathy

• Impact of ASyS and EAs on disability and functional outcomes

• Immediate and late neuroimaging features of ASyS and/or acute EAs

• Late electrophysiological markers and remnants of ASyS and/or acute EAs

• ASM use after ASyS for preventing ASyS recurrence (secondary prophylaxis)

• Multi-modal predictors of successful ASyS control using ASMs

• ASM use after detection of acute EAs: pros and cons

• Local, national, or international practices of ASM use after ASyS and/or acute EAs

• Epilepsy development after ASyS and/or acute EAs

• Multi-modal predictors of epilepsy development in patients with ASyS and/or acute EAs

• Etiology specific ASyS risk and features

• Clinical vs. electrographic ASyS: Differences and similarities

• Translational studies on animal models of ASyS and implications in humans

Keywords: symptomatic seizures, provoked seizures, continuous EEG, cEEG, Lateralized periodic discharges, LPDs, periodic patterns, GPDs, anti-seizure medications, epileptogenesis

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