Seizure syndrome in stroke and traumatic brain injury: Incidence and treatment outcomes in the intensive care unit

Seizure syndrome is one of the most common and complex neurological complications in patients with acute brain injuries, particularly following stroke and traumatic brain injury. This complication significantly worsens clinical outcomes, increases the risk of mortality, and prolongs patients’ length of stay in the intensive care unit. This study aimed to determine the frequency of seizure syndrome in patients with stroke and traumatic brain injury, to analyse the main causes of its development, and to evaluate the efficacy and safety of antiepileptic therapy in order to improve treatment approaches and clinical outcomes. A comprehensive literature review was conducted using 50 relevant scientific publications from PubMed, Scopus, Web of Science and Google Scholar databases. The selection was carried out in accordance with PRISMA guidelines and included studies with clearly defined patient populations with stroke or traumatic brain injury, data on seizure frequency, antiepileptic drug use, and statistically analysed results published in peer reviewed journals. Published studies indicated that seizure syndrome occurs in approximately 15%- 30% of patients after stroke and in 20%-40% of individuals with traumatic brain injury. Early seizures (within the first seven days) are consistently reported in approximately 7% of patients after stroke and are associated with a poorer prognosis. The literature review identified multifactorial pathophysiological mechanisms, including primary structural brain tissue damage, secondary metabolic disorders, neuroinflammation, and an imbalance of neurotransmitter systems. Data from numerous studies demonstrated a high efficacy of modern antiepileptic therapy – particularly levetiracetam and lorazepam – estimated at 70%-85% with a favourable safety profile. The binding of levetiracetam to synaptic vesicle protein 2A is widely regarded as a key mechanism of seizure control, while lorazepam remains a first-line drug for the acute management of seizures due to its enhancement of GABAergic transmission