Sara Gasparini1,2, Edoardo Ferlazzo1,2,3, Chiara Sueri2, Vittoria Cianci2, Michele Ascoli2, Salvatore M Cavalli2, Ettore Beghi4, Vincenzo Belcastro5, Amedeo Bianchi6, Paolo Benna7, Roberto Cantello8, Domenico Consoli9, Fabrizio A De Falco10, Giancarlo Di Gennaro11, Antonio Gambardella1,3, Gian Luigi Gigli12, Alfonso Iudice13, Angelo Labate1,3, Roberto Michelucci14, Maurizio Paciaroni15, Pasquale Palumbo16, Alberto Primavera17, Ferdinando Sartucci13, Pasquale Striano18, Flavio Villani19, Emilio Russo20, Giovambattista De Sarro20, Umberto Aguglia21,22,23,24. 1. Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy. 2. Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio Calabria, Italy. 3. Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy. 4. Department of Neuroscience, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. 5. Neurology Unit, S. Anna Hospital, Como, Italy. 6. Department of Neurology and Epilepsy Centre, San Donato Hospital, Arezzo, Italy. 7. Department of Neurosciences and Mental Health, Città della Salute e della Scienza University Hospital, Torino, Italy. 8. Neurology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy. 9. Vibo Valentia Health Authority, Vibo Valentia, Italy. 10. Neurology Unit, Ospedale del Mare, Via Enrico Russo, Naples, Italy. 11. IRCCS "NEUROMED", Pozzilli, Isernia, Italy. 12. Neurology Unit, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy. 13. Department of Clinical and Experimental Medicine, Section of Neurology, University of Pisa, Pisa, Italy. 14. IRCCS Institute of Neurological Sciences, Neurology Unit, Bellaria Hospital, Bologna, Italy. 15. Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy. 16. Local Health Unit, Prato, Italy. 17. Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy. 18. Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genoa, Italy. 19. Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 20. Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro, Italy. 21. Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy. u.aguglia@gmail.com. 22. Regional Epilepsy Centre, Great Metropolitan Hospital, Via Melacrino, Reggio Calabria, Italy. u.aguglia@gmail.com. 23. Institute of Molecular Bioimaging and Physiology, National Research Council, Viale Europa, Catanzaro, Italy. u.aguglia@gmail.com. 24. Regional Epilepsy Centre, Magna Graecia University of Catanzaro, Riuniti Hospital, Via Melacrino, Reggio Calabria, Italy. u.aguglia@gmail.com.
Abstract
BACKGROUND: Epilepsy and hypertension are common chronic conditions, both showing high prevalence in older age groups. This review outlines current experimental and clinical evidence on both direct and indirect role of hypertension in epileptogenesis and discusses the principles of drug treatment in patients with hypertension and epilepsy. METHODS: We selected English-written articles on epilepsy, hypertension, stroke, and cerebrovascular disease until December, 2018. RESULTS: Renin-angiotensin system might play a central role in the direct interaction between hypertension and epilepsy, but other mechanisms may be contemplated. Large-artery stroke, small vessel disease and posterior reversible leukoencephalopathy syndrome are hypertension-related brain lesions able to determine epilepsy by indirect mechanisms. The role of hypertension as an independent risk factor for post-stroke epilepsy has not been demonstrated. The role of hypertension-related small vessel disease in adult-onset epilepsy has been demonstrated. Posterior reversible encephalopathy syndrome is an acute condition, often caused by a hypertensive crisis, associated with the occurrence of acute symptomatic seizures. Chronic antiepileptic treatment should consider the risk of drug-drug interactions with antihypertensives. CONCLUSIONS: Current evidence from preclinical and clinical studies supports the vision that hypertension may be a cause of seizures and epilepsy through direct or indirect mechanisms. In both post-stroke epilepsy and small vessel disease-associated epilepsy, chronic antiepileptic treatment is recommended. In posterior reversible encephalopathy syndrome blood pressure must be rapidly lowered and prompt antiepileptic treatment should be initiated.
BACKGROUND:Epilepsy and hypertension are common chronic conditions, both showing high prevalence in older age groups. This review outlines current experimental and clinical evidence on both direct and indirect role of hypertension in epileptogenesis and discusses the principles of drug treatment in patients with hypertension and epilepsy. METHODS: We selected English-written articles on epilepsy, hypertension, stroke, and cerebrovascular disease until December, 2018. RESULTS: Renin-angiotensin system might play a central role in the direct interaction between hypertension and epilepsy, but other mechanisms may be contemplated. Large-artery stroke, small vessel disease and posterior reversible leukoencephalopathy syndrome are hypertension-related brain lesions able to determine epilepsy by indirect mechanisms. The role of hypertension as an independent risk factor for post-stroke epilepsy has not been demonstrated. The role of hypertension-related small vessel disease in adult-onset epilepsy has been demonstrated. Posterior reversible encephalopathy syndrome is an acute condition, often caused by a hypertensive crisis, associated with the occurrence of acute symptomatic seizures. Chronic antiepileptic treatment should consider the risk of drug-drug interactions with antihypertensives. CONCLUSIONS: Current evidence from preclinical and clinical studies supports the vision that hypertension may be a cause of seizures and epilepsy through direct or indirect mechanisms. In both post-stroke epilepsy and small vessel disease-associated epilepsy, chronic antiepileptic treatment is recommended. In posterior reversible encephalopathy syndrome blood pressure must be rapidly lowered and prompt antiepileptic treatment should be initiated.
Authors: N F Moran; D R Fish; N Kitchen; S Shorvon; B E Kendall; J M Stevens Journal: J Neurol Neurosurg Psychiatry Date: 1999-05 Impact factor: 10.154
Authors: Brenda G Fahy; Jean E Cibula; W Travis Johnson; Lou Ann Cooper; David Lizdas; Nikolaus Gravenstein; Samsun Lampotang Journal: Neurol Sci Date: 2020-07-23 Impact factor: 3.307
Authors: Wyatt P Bensken; Guadalupe Fernandez-Baca Vaca; Barbara C Jobst; Scott M Williams; Kurt C Stange; Martha Sajatovic; Siran M Koroukian Journal: Neurology Date: 2021-10-27 Impact factor: 11.800
Authors: Elena Tartara; Elisa Micalizzi; Sofia Scanziani; Elena Ballante; Matteo Paoletti; Carlo Andrea Galimberti Journal: Front Neurol Date: 2022-02-23 Impact factor: 4.003
Authors: Fulvio A Scorza; Antonio Carlos G de Almeida; Carla A Scorza; Josef Finsterer Journal: Clinics (Sao Paulo) Date: 2021-06-11 Impact factor: 2.365