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Advanced Neurology

REVIEW ARTICLE
Seizures and chronic kidney disease: An in-depth

review

1
Henry H.L. Wu *, Claire C.Y. Wang , Suresh K. Chhetri , Arvind Ponnusamy ,
3,4
2
2
and Paul Warwicker 3
1 Department of Renal Research, Kolling Institute of Medical Research, Royal North Shore Hospital
and The University of Sydney, Sydney, NSW, Australia
2 Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston,
United Kingdom
3 Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston,
United Kingdom
4 Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom

Abstract
Seizures are not uncommon in patients with chronic kidney disease (CKD), with an
approximate incidence of roughly 10%. There are two primary groups: Patients who
develop acute provoked seizures in the setting of CKD and patients with pre-existing
epilepsy who then develop CKD. The recognition of potential etiology and
management of seizures in this patient population may be challenging for clinicians,
particularly non-neurologists. Standard antiepileptic drug (AED) treatment is indicated
for those with pre-existing epilepsy. The prescription of AED in CKD population
requires careful consideration, due to potentially altered pharmacokinetics. Clinicians
frequently encounter challenges in the selection, loading, titration, and maintenance
*Corresponding author: of AEDs. There are few internationally recognized consensus recommendations for
Henry H.L. Wu AED prescription in CKD and dialysis. Non-AED management aims at addressing
(honlinhenry.wu@health.nsw.gov.au)
factors that may have provoked the seizure. In this article, we provide an in-depth
Citation: Wu HHL, Wang CCY, review of the potential etiologies and pathophysiological pathways of provoked
Chhetri SK, et al., 2023, Seizures seizures in CKD. We discuss strategies, including non-AED treatment options, which
and chronic kidney disease: An
in-depth review. Adv Neuro, aim to prevent, and/or manage provoked seizures in the setting of CKD. We discuss
2(2): 314. the AEDs used in contemporary clinical practice and how their metabolism is affected
https://doi.org/10.36922/an.314 by CKD, concurrent AED prescriptions, and dialysis.
Received: December 27, 2022
Accepted: April 3, 2023 Keywords: Seizures; Chronic kidney disease; Pathophysiology; Etiology; Management;
Published Online: April 12, 2023 Antiepileptic drugs
Copyright: © 2023 Author(s).
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution 1. Introduction
License, permitting distribution,
and reproduction in any medium, A seizure is a state of transient alteration in neurological function because of paroxysmal,
provided the original work is excessive, and synchronous surges of neuronal activity in the brain . They may be
[1]
properly cited.
unprovoked or provoked, for example, by hypoxic-ischemic injury, electrolyte, and
Publisher’s Note: AccScience metabolic disturbances including uremia, medication, and illicit drug intoxication,
Publishing remains neutral with
regard to jurisdictional claims in withdrawal of drugs and/or alcohol, infections, and traumatic brain/neurovascular
published maps and institutional injury (Table 1) [1-8] . Although provoked seizures, also termed acute symptomatic
affiliations.

Volume 2 Issue 2 (2023) 1 https://doi.org/10.36922/an.314