epilepsiaEpilepsy and paroxysmal conditionsЭпилепсия и пароксизмальные состояния2077-83332311-4088IRBIS LLC10.17749/2077-8333/epi.par.con.2023.135epilepsia-907Research ArticleSCIENTIFIC SURVEYSНАУЧНЫЕ ОБЗОРЫPost-stroke epileptic seizures: risk factors, clinical presentation, principles of diagnosis and treatmentПостинсультные эпилептические приступы: факторы риска, клиническая картина, принципы диагностики и леченияhttps://orcid.org/0000-0002-8988-1240Аль-СахлиУ. А. М.Al-SahliO. A.M.

Аль-Сахли Усама Абдулвахаб Мохаммед – клинический аспирант кафедры нейрохирургии и неврологии

Университетская наб., д. 7-9, Санкт-Петербург 199034,

Osamah A.M. Al-Sahli – Clinical Postgraduate, Chair of Neurosurgery and Neurology

7-9 University Emb., Saint Petersburg 199034

ycama2020@gmail.comhttps://orcid.org/0000-0002-8347-4425ТибекинаЛ. М.TibekinaL. М.

Тибекина Людмила Михайловна – д.м.н., профессор кафедры нейрохирургии и неврологии

WoS ResearcherID: G-7936-2015; Scopus Author ID: 6507271711

Университетская наб., д. 7-9, Санкт-Петербург 199034

Lyudmila М. Tibekina – Dr. Med. Sc., Professor, Chair of Neurosurgery and Neurology

WoS ResearcherID: G-7936-2015; Scopus Author ID: 6507271711

7-9 University Emb., Saint Petersburg 199034

https://orcid.org/0000-0002-4379-0693СубботинаО. П.SubbotinaO. P.

Субботина Ольга Павловна – врач невролог-эпилептолог, нейрофизиолог

ул. Академика Павлова, д. 9, Санкт-Петербург 197376

Olga P. Subbotina – Neurologist-Epileptologist, Neurophysiologist

9 Academician Popov Str., Saint Petersburg 197376

https://orcid.org/0000-0001-9441-0155ФлудВ. В.FludV. V.

Флуд Виктор Васильевич – к.м.н., ассистент кафедры нейрохирургии и неврологии

WoS ResearcherID: G-7026-2015

Университетская наб., д. 7-9, Санкт-Петербург 199034

Viktor V. Flud – MD, PhD, Assistant Professor, Chair of Neurosurgery and Neurology

WoS ResearcherID: G-7026-2015

7-9 University Emb., Saint Petersburg 199034

Федеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный университет»РоссияSaint Petersburg State UniversityRussian FederationФедеральное государственное бюджетное учреждение науки «Институт мозга человека им. Н.П. Бехтеревой» Российской академии наукРоссияBekhtereva Institute of Human Brain, RASRussian Federation202309072023152148159Copyright © Al-Sahli O.A., Tibekina L.М., Subbotina O.P., Flud V.V., 20232023Аль-Сахли У.А., Тибекина Л.М., Субботина О.П., Флуд В.В.Al-Sahli O.A., Tibekina L.М., Subbotina O.P., Flud V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epilepsia.su/jour/article/view/907

Post-stroke developing epileptic seizures represent a severe complication aggravating post-stroke condition. Epilepsy can exacerbate cognitive, psychopathological, somatic disorders resulting from cerebrovascular and comorbid diseases. Despite that post-stroke epilepsy (PSE) is a rather common type of acquired structural epilepsy, the issues related to diagnosis and management often raise difficulties for clinicians. Patients with severe strokes affecting brain, cortex, acute symptomatic seizures and intracerebral hemorrhage are at greater risk of developing PSE. Timely neurophysiological, neuroradiological research methods, assessed blood biomarkers as well as prognostic models provide information that complements PSE clinical risk factors. The management of post-stroke acute and long-term (late) symptomatic seizures differs markedly. At the same time, the choice of an optimal anticonvulsant drug should be based not only on its effectiveness, but also on related side effects, pharmacodynamics as well as an impact on concomitant diseases. Drug interactions, especially between anticonvulsants and anticoagulants or antiplatelet agents also affect a choice of treatment, which should be taken into consideration for management of PSE patients.

Эпилептические приступы, развивающиеся после инсульта, – серьезное осложнение, которое отягощает постинсультное состояние. Эпилепсия может усугублять когнитивные, психопатологические, соматические расстройства, являющиеся следствием цереброваскулярных и коморбидных заболеваний. Несмотря на то что постинсультная эпилепсия (ПИЭ) представляет собой достаточно распространенную форму приобретенной структурной эпилепсии, вопросы ее диагностики и ведения таких больных вызывают трудности у клиницистов. Пациенты с тяжелыми инсультами с вовлечением коры, острыми симптоматическими приступами и внутримозговым кровоизлиянием имеют больший риск развития ПИЭ. Своевременные нейрофизиологические, нейрорадиологические методы исследования, определение биомаркеров крови, прогностические модели предоставляют информацию, дополняющую клинические факторы риска ПИЭ. Принципы ведения больных с острыми эпилептическими приступами и в отдаленном периоде после инсульта заметно отличаются. При этом выбор оптимального противосудорожного препарата должен основываться не только на его эффективности, но и на побочных эффектах, фармакодинамике и воздействии на сопутствующие заболевания. Лекарственные взаимодействия, особенно между противосудорожными препаратами и антикоагулянтами или антиагрегантами, также влияют на выбор лечения, что необходимо учитывать при ведении пациентов с ПИЭ.

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The authors declare that there are no conflicts of interest present.