Acute symptomatic seizure: structural brain lesions, metabolic disorders, anti-seizure medications

Seizures that occur in close temporal relation to brain lesions and do not recur after resolution of the pathological condition or elimination of the factor that caused it should be considered as acute symptomatic seizures. They differ from unprovoked seizures and epilepsy because the risk of recurrence is significantly lower and there is no long-term predisposition to further seizures. The most important causes of acute symptomatic seizures in adults are both diseases that lead to structural brain damage, such as ischemic stroke, cerebral hemorrhage, brain trauma, or encephalitis, and factors that do not affect the structural integrity of the brain, such as metabolic disorders and intoxications. Patients with acute symptomatic seizures have a high risk of mortality in the first weeks after the event. They should be treated with anti-seizure medications during the acute phase of the underlying disease, as this may prevent subsequent acute symptomatic seizure. Treatment should focus on managing the underlying disease and correcting or eliminating the conditions or factors that provoke seizure. Long-term treatment with anti-seizure medications is usually not necessary, and anticonvulsants should be gradually withdrawn over several weeks or months following the acute symptomatic seizure.