ABSTRACT

To date, no guideline exists for the management of epilepsy in patients with prolonged Disorders of Consciousness (DoC). This review aimed to assess the occurrence of epilepsy and epileptic abnormalities (EA) in these patients, to determine their impact on recovery; and to review the effect of antiepileptic drugs (AED) and therapeutic interventions on seizure occurrence and consciousness recovery. A structured search for studies on prolonged DoC and epilepsy was undertaken following PRISMA guidelines. From an initial search resulting in 5,775 titles, twelve studies met inclusion criteria. The occurrence of epilepsy and EA in DoC was poorly and inconsistently reported across studies. The results estimated a seizure prevalence of 27% in DoC. No conclusive data were found for the effects of AED on recovery nor on the influence of any therapeutic interventions on seizure occurrence. Given the scarcity of data, it is premature to make evidence-based recommendations on epilepsy in prolonged DoC. Based on this review and current clinical practices the following are recommended: (1) repeated standard EEG for detecting seizures and EA; (2) treating epilepsy while avoiding AEDs with sedating or cognitive side-effects. Future research should use standardized classification systems for seizures and EA.

摘要

迄今为止，尚无关于长期意识障碍 (DoC) 患者癫痫管理的指南。本综述旨在评估这些患者中癫痫和癫痫异常 (EA) 的发生情况，以确定它们对康复的影响；并审查抗癫痫药 (AED) 和治疗干预对癫痫发作和意识恢复的影响。遵循 PRISMA 指南对延长的 DoC 和癫痫的研究进行了结构化搜索。从最初搜索到 5,775 个标题，十二项研究符合纳入标准。DoC 中癫痫和 EA 的发生在各研究中的报告很差且不一致。结果估计，DoC 中的癫痫患病率为 27%。没有发现 AED 对恢复的影响以及任何治疗干预对癫痫发作的影响的结论性数据。鉴于数据稀缺，在长期 DoC 中对癫痫提出循证建议还为时过早。基于本综述和当前的临床实践，推荐以下内容：（1）重复标准 EEG 检测癫痫发作和 EA；(2)治疗癫痫同时避免具有镇静或认知副作用的AED。未来的研究应该对癫痫发作和 EA 使用标准化的分类系统。(2)治疗癫痫同时避免具有镇静或认知副作用的AED。未来的研究应该对癫痫发作和 EA 使用标准化的分类系统。(2)治疗癫痫同时避免具有镇静或认知副作用的AED。未来的研究应该对癫痫发作和 EA 使用标准化的分类系统。