Epilepsy after neuroimaging normalization in a woman with tacrolimus-related posterior reversible encephalopathy syndrome

Baldini, Mariella; Bartolini, Emanuele; Gori, Sara; Bonanni, Enrica; Cosottini, Mirco; Iudice, Alfonso; Murri, Luigi

doi:10.1016/j.yebeh.2010.01.014

Cited by 22 publications

(11 citation statements)

References 7 publications

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“…Patients with seizures should be treated with antiepileptic drugs, but for how long is controversial. Although there is a case report of a PRES patient who developed epilepsy despite complete resolution of the MRI lesions,40 seizures do not normally progress to chronic epilepsy 3 8 9. Therefore, we suggest that antiepileptic drugs should not be given for more than 3 months unless there is ongoing epileptic activity on the EEG or recurrent seizures.…”

Section: Managementmentioning

confidence: 90%

The posterior reversible encephalopathy syndrome: what's certain, what's new?

Roth

Ferbert²

2011

Practical Neurology

220

260

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The posterior reversible encephalopathy syndrome is an increasingly recognised disorder. Most patients have several symptoms; seizures are the most frequent, often multiple or status epilepticus. A combination of seizures, visual disturbance and/or headache, in particular, should lead to an early brain MRI to reveal the typical pattern of bilateral hyperintensities on fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. There seem to be many possible triggers, including abrupt arterial hypertension, impaired renal function, pregnancy, immunosuppressive therapies and various inflammatory conditions. The clinical outcome is excellent, with recovery within a few days, while the MRI abnormalities resolve much more slowly. Little is known about the best management. Seizures do not normally progress to chronic epilepsy so antiepileptic drugs should be discontinued after about 3 months.

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Section: Managementmentioning

confidence: 90%

The posterior reversible encephalopathy syndrome: what's certain, what's new?

Roth

Ferbert²

2011

Practical Neurology

220

260

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“…However, the primary goal of this study was to describe EEG findings, not risk of subsequent epilepsy, and 32 patients with PRES were excluded from the analysis (including 21 with seizures) . There is likely a small risk of recurrent seizures in some patients after PRES, and this has been described in isolated case reports . One report described a post‐liver transplantation patient with PRES who had recurrent seizures despite normalization of neuroimaging.…”

Section: Discussionmentioning

confidence: 99%

Long‐term risk of seizures and epilepsy in patients with posterior reversible encephalopathy syndrome

et al. 2015

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SUMMARYObjective: Seizures are common in patients with posterior reversible encephalopathy syndrome (PRES), which is reported in up to 70% of cases, and antiepileptic drugs (AEDs) are commonly prescribed. There is a paucity of data regarding the risk of subsequent seizures following resolution of PRES, and therefore the optimal duration of treatment with AEDs is currently unknown. The objective of this study was to identify the frequency of recurrent seizures and epilepsy following recovery from PRES. Methods: We performed a retrospective review of consecutive adults diagnosed with PRES between 2000 and 2010. Results: One hundred twenty-seven patients, median age 53 years (interquartile range [IQR] 37-64), were included in the analysis. The most common causes of PRES were hypertension (72%) and immunosuppression (20%). Renal failure was present in 47%. Eighty-four patients (66%) had seizures at presentation (39 focal, 45 generalized), and 13 (15%) of them presented with status epilepticus. Median duration of follow-up was 3.2 years (IQR 4 months to 6.9 years). Patients with seizures were treated with AEDs for a median of 3 months (IQR 2-7). Fifteen patients (12%) had provoked seizures during the follow-up period; in eight (53%) patients seizures were caused by recurrent PRES. Only three patients had subsequent unprovoked seizures, one of whom was considered to have developed epilepsy. Significance: We conclude that unprovoked seizures and epilepsy are uncommon in patients who have recovered from PRES. Discontinuation of AEDs following resolution of PRES should be considered, provided there is adequate control of risk factors, and absence of factors that could substantially lower the seizure threshold.

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“…There are two recent reports of patients with PRES having persistent epilepsy and EEG abnormalities. One patient suffered recurrent seizures despite MRI normalization following liver transplantation [13]. One patient with recurrent PRES and PLEDs developed chronic epilepsy [14].…”

Section: Discussionmentioning

confidence: 99%

“…This supports the assumption that symptomatic epileptic seizures in otherwise uncomplicated PRES are generally benign. The above-mentioned reports of PRES with long-term sequelae do not necessarily revoke this assumption, since frequent repeated episodes of PRES can imply persistent structural damage [14] and in the patient with liver transplantation, repeated use of several immunosuppressants could cause persistent epilepsy [13]. Incomplete remission of brain abnormalities is reportedly a potential etiology of persistent seizures [16].…”

Section: Discussionmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome (PRES): electroencephalographic findings and seizure patterns

et al. 2011

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To better describe seizure type, frequency, and electroencephalographic (EEG) findings in posterior reversible encephalopathy syndrome (PRES) and correlate these data with clinical and magnetic resonance imaging (MRI) data, we retrospectively assessed medical charts and EEG studies of patients with PRES treated between 2004 and 2011. Data collected included patients' underlying pathology, lesion distribution by MRI, seizure type and frequency, EEG pathologic background activity, focal pathology, and epileptogenic activity. Thirty-eight of 49 adults with PRES suffered from seizures; 17 underwent EEG and were included in the analysis. Perpetuating factors were similar to those reported in the literature. In 15 of 17 patients, MRI showed widespread involvement rather than purely occipital lesions. Nine patients had subcortical and cortical involvement. Seizures were single short grand mal (GM) in 11, serial GM in 2, recurrent GM in 2, and additional focal seizures in 2. No seizures were noted beyond the first day. After discontinuation of antiepileptic medication, no patients experienced seizure recurrence during 6-month follow-up. EEG showed diffuse theta/delta slowing in 13 patients and epileptogenic activity with focal sharp-wave and periodic lateralizing epileptiform discharges in 2 patients. Seizures in PRES are most commonly single GM and are usually of limited duration. EEG shows variable theta/delta slowing. Focal EEG pathology is seen in patients with focal seizures. Seizures occur early after disease onset and terminate spontaneously or under therapy during the first 24 h. Seizure recurrence beyond 24 h and chronic epilepsy were not seen. Seizures in PRES are frequent but appear to be uncomplicated and do not herald worse prognosis. EEG is helpful in evaluating the degree of encephalopathy and monitoring epileptic activity. Long-term antiepileptic medication does not appear to be warranted.

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Epilepsy after neuroimaging normalization in a woman with tacrolimus-related posterior reversible encephalopathy syndrome

Cited by 22 publications

References 7 publications

The posterior reversible encephalopathy syndrome: what's certain, what's new?

The posterior reversible encephalopathy syndrome: what's certain, what's new?

Long‐term risk of seizures and epilepsy in patients with posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES): electroencephalographic findings and seizure patterns

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