Advance in stroke treatment have resulted in a dramatic reduction in the stroke mortality,
however, the number of stroke survivors living with morbidity has increased significantly. As
we know, post-stroke epilepsy has been identified as a significant clinical issue in stroke
survivors and stroke is the most common cause of epilepsy in older adults and for patients
aged more than 65, post-stroke epilepsy accounts for 30-50% of new-onset seizures. Our
previous study documented seizures during stroke presentation and during hospitalization
would worsen the overall morbidity and mortality, suggesting the importance of awareness in
seizure care in acute ischemic stroke.
As current studies only focus on anti-seizure/anti-convulsion after the appearance of
late-onset seizures, without the intervention of the epileptogenesis, it is important to
develop a potential novel prophylactic treatment on patients with acute severe stroke to
prevent from late occurrence of seizures and epilepsy.
We have previously done researches on the medications that might have potential of
anti-epileptogenesis in pilocarpine-induced animal models, supporting the concept of
antiepileptogenesis, giving intervention immediately following a brain insult.
The results of some earlier anecdotal reports or small studies on prophylactic use of
antiepileptic drug (AED) therapy in stroke, either hemorrhagic or ischemic strokes, remain
inconclusive. There still lacks a well-established case-control study on prophylaxis of
post-stroke epilepsy, with the early intervention of AED therapy with potential of
anti-epileptogenesis in the phase of epileptogenesis.
Based on our clinical experience, and laboratory researches, we have noted two
non-conventional AEDs, levetiracetam (LEV) and perampanel (PER) with potential of
anti-epileptogenesis. It is justified to evaluate if early administration of LEV or PER in
patients with acute major stroke as a prophylactic therapy could hamper the development of
epileptogenesis and the later post-stroke epilepsy.
We aim to conduct a randomized case-control study to evaluate if early prophylactic
introduction of low dose AED therapy (LEV or PER) in patients with moderate to severe middle
cerebral artery infarct, could prevent the development of post-stroke epilepsy (primary
prevention).
Phase:
N/A
Details
Lead Sponsor:
National Cheng Kung University
Collaborators:
Ministry of Science and Technology, Taiwan National Cheng-Kung University Hospital