Abstract：
OBJECTIVE: To evaluate and synthesize the evidence and knowledge gaps on primary prevention and treatment of post-stroke acute symptomatic seizures (ASSs) using antiseizure medications (ASMs).
METHODS: We systematically searched of EMBASE, MEDLINE (accessed from PubMed), and the Cochrane Central Register of Controlled Trials (CENTRAL) to include randomized, double- or single-blinded trials (RCTs) on primary prophylaxis and treatment of post-stroke ASSs with ASMs. The risk of bias in the included studies was assessed according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS: Two placebo-controlled RCTs (totaling 114 participants) evaluating valproate or levetiracetam as primary prophylaxis of ASSs due to hemorrhagic stroke were included. In one RCT, post-stroke ASS occurred in 1/36 patients (2.7%) on valproate and in 4/36 patients (7%) on placebo (p = 0.4). In the other RCT, ASSs were only electrographic and occurred in 3/19 (16%) with levetiracetam and in 10/23 (43%) with placebo (p = 0.043). We found no RCTs on the treatment of post-stroke ASSs or discontinuation of ASMs administered for the treatment of post-stroke ASSs.
CONCLUSIONS: Evidence to support primary prophylaxis of ASSs is sparse and of very low quality and is insufficient to recommend it routinely. Secondary prevention of post-stroke ASSs is usually not recommended except in selected cases (the most relevant being acute symptomatic status epilepticus, which carries a high risk of subsequent poststroke seizures (PSE)). The choice of which ASM to administer and for how long is not based on solid RCT evidence. Management of post-stroke PSE should be done according to an evidence-based framework, considering the individuality of the patient and the pharmacological properties of the drugs.
METHODS: We systematically searched of EMBASE, MEDLINE (accessed from PubMed), and the Cochrane Central Register of Controlled Trials (CENTRAL) to include randomized, double- or single-blinded trials (RCTs) on primary prophylaxis and treatment of post-stroke ASSs with ASMs. The risk of bias in the included studies was assessed according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS: Two placebo-controlled RCTs (totaling 114 participants) evaluating valproate or levetiracetam as primary prophylaxis of ASSs due to hemorrhagic stroke were included. In one RCT, post-stroke ASS occurred in 1/36 patients (2.7%) on valproate and in 4/36 patients (7%) on placebo (p = 0.4). In the other RCT, ASSs were only electrographic and occurred in 3/19 (16%) with levetiracetam and in 10/23 (43%) with placebo (p = 0.043). We found no RCTs on the treatment of post-stroke ASSs or discontinuation of ASMs administered for the treatment of post-stroke ASSs.
CONCLUSIONS: Evidence to support primary prophylaxis of ASSs is sparse and of very low quality and is insufficient to recommend it routinely. Secondary prevention of post-stroke ASSs is usually not recommended except in selected cases (the most relevant being acute symptomatic status epilepticus, which carries a high risk of subsequent poststroke seizures (PSE)). The choice of which ASM to administer and for how long is not based on solid RCT evidence. Management of post-stroke PSE should be done according to an evidence-based framework, considering the individuality of the patient and the pharmacological properties of the drugs.
摘要：
目的：评估和综合使用抗癫痫药物（ASM）预防和治疗卒中后急性症状性癫痫（ASS）的证据和知识差距。
方法：我们系统地搜索了EMBASE，MEDLINE（从PubMed访问），和Cochrane中央对照试验登记册（CENTRAL）包括随机，关于使用ASM的卒中后ASS的一级预防和治疗的双盲或单盲试验(RCTs)。根据《Cochrane干预措施系统评价手册》的建议,对纳入研究的偏倚风险进行评估。
结果：包括两个安慰剂对照RCT（共114名参与者），评估丙戊酸盐或左乙拉西坦作为出血性中风引起的ASS的主要预防。在一个RCT中，1/36例患者(2.7%)服用丙戊酸盐,4/36例患者(7%)服用安慰剂(p=0.4)发生卒中后ASS.在另一个RCT中，ASS仅是电描记法，左乙拉西坦在3/19（16％）中发生，安慰剂在10/23（43％）中发生（p=0.043）。我们没有发现关于卒中后ASSs治疗或停止用于卒中后ASSs治疗的ASMs的随机对照试验。
结论：支持ASS一级预防的证据很少，质量很低，不足以常规推荐。通常不建议对卒中后ASSs进行二级预防，除非在某些情况下（最相关的是急性症状性癫痫持续状态，这带来了随后的卒中后癫痫发作（PSE）的高风险。选择哪种ASM管理以及管理多长时间并不基于可靠的RCT证据。卒中后PSE的管理应根据循证框架进行，考虑患者的个性和药物的药理特性。
方法：我们系统地搜索了EMBASE，MEDLINE（从PubMed访问），和Cochrane中央对照试验登记册（CENTRAL）包括随机，关于使用ASM的卒中后ASS的一级预防和治疗的双盲或单盲试验(RCTs)。根据《Cochrane干预措施系统评价手册》的建议,对纳入研究的偏倚风险进行评估。
结果：包括两个安慰剂对照RCT（共114名参与者），评估丙戊酸盐或左乙拉西坦作为出血性中风引起的ASS的主要预防。在一个RCT中，1/36例患者(2.7%)服用丙戊酸盐,4/36例患者(7%)服用安慰剂(p=0.4)发生卒中后ASS.在另一个RCT中，ASS仅是电描记法，左乙拉西坦在3/19（16％）中发生，安慰剂在10/23（43％）中发生（p=0.043）。我们没有发现关于卒中后ASSs治疗或停止用于卒中后ASSs治疗的ASMs的随机对照试验。
结论：支持ASS一级预防的证据很少，质量很低，不足以常规推荐。通常不建议对卒中后ASSs进行二级预防，除非在某些情况下（最相关的是急性症状性癫痫持续状态，这带来了随后的卒中后癫痫发作（PSE）的高风险。选择哪种ASM管理以及管理多长时间并不基于可靠的RCT证据。卒中后PSE的管理应根据循证框架进行，考虑患者的个性和药物的药理特性。
