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Advanced Neurology Seizures and CKD

Table 1. Potential causes of provoked seizures CKD experience seizures [15,16] . Onset of seizure occurs
in approximately one-third of patients presenting with
Causes of provoked seizures Potential etiologies uremic encephalopathy, resulting from acute-on-chronic
Hypoxic-ischemic injury [1-8] Cardiac arrest kidney injury (AKI-on-CKD) or severe advanced CKD .
[9]
Hypotension
Hypovolemia The prescription of antiepileptic drugs (AEDs), either as
Hanging or drowning monotherapy or combined AED therapies, may not always
Electrolyte and metabolic Uremia be necessary in patients with provoked seizures [9,16] . The
imbalances [1-8] Hypo/hypernatremia early detection and timely management of the metabolic
Hypo/hyperglycemia (i.e., disturbances which precipitated the seizure is more
non-ketotic hyperglycemia)
Hyperthyroidism important. Epilepsy is defined by the occurrence of two
Porphyria unprovoked seizures, at least 24 h apart, or one unprovoked
Medication and illicit drug Cocaine seizure and a likelihood of additional seizure occurrence of
(and alcohol) intoxications [1-8] Phencyclidine at least 60% in the next 10 years (as defined by the 2014
Opioids – e.g., tramadol, meperidine International League Against Epilepsy guidelines). Patients
Amphetamines with existing CKD and epilepsy, experiencing unprovoked
Alcohol seizures or persistent seizure occurrences, and inevitably
Withdrawal of drugs Benzodiazepines require AED prescription(s) [1,9,16] . Prescribing AEDs for
(and/or alcohol) [1-8] Bupropion
Tramadol CKD patients, with consequent altered pharmacokinetics,
Alcohol are challenging. Many AEDs undergo both renal and
Traumatic brain and Blunt or penetrating trauma dialytic clearance.
neurovascular injuries [1-8] High-impact accident (i.e., motor In this review, the etiologies and potential
vehicle accidents)
Falls with head injury pathophysiological pathways of provoked seizures in the
Ischemic stroke setting of CKD is explored, including the dialysis and post-
Subarachnoid and/or transplant populations. We discuss not only prophylactic
intraparenchymal hemorrhages measures which aim to prevent seizures, but also non-
Systemic sepsis and other Viral (HSV especially common) AED treatment options to manage and limit exacerbations
infections [1-8] Bacterial of CKD-associated seizures. We discuss the AEDs used in
Parasitic contemporary clinical practice, and how their metabolism
Others [1-8] Eclampsia may be affected by CKD, interactions with other AEDs,
PRES
Febrile illness of unknown origin and dialysis.
HSV: Herpes simplex virus; PRES: Posterior reversible encephalopathy 2. Etiologies and pathophysiological
syndrome
pathways of provoked seizures in CKD
seizures, can occur in an otherwise healthy person with The fundamental mechanism of neuronal excitability is
no structural brain abnormalities or remote brain insult, a the action potential. An action potential is defined as a
higher burden of comorbidities increases this risk . hyperexcitable state that results from increased excitatory
[9]
Chronic kidney disease (CKD) is defined by a synaptic neurotransmission, decreased inhibitory
progressive deterioration of kidney function. The Kidney neurotransmission, change in voltage-gated ion channels,
Disease Improving Global Outcomes (KDIGO) initiative and/or a change of intra-cellular or extra-cellular ion
[17]
defines CKD as an abnormality in kidney function or concentrations in favor of membrane depolarization .
structure that persists beyond 3 months . The global Seizures disrupt the normal physiological cycle of the
[10]
prevalence of CKD has substantially increased over recent neuronal membrane. Any disturbance of the neuronal
years, because of an aging population and the increased membrane may lead to inappropriate depolarization and
prevalence of Type 2 diabetes progressing to diabetic repeated action potentials, propagating down the axon
nephropathy [11,12] . Approximately 15% of the general and inducing release of neurotransmitters (e.g., glutamate,
population is classified as having CKD. It is projected to gamma-amino-butyric acid [GABA], acetylcholine,
become the fifth leading cause of worldwide mortality by norepinephrine, dopamine, serotonin, and histamine) at
[18]
2040 . Electrolyte imbalance and uremia are recognized the axonal terminal . Membrane depolarization usually
[13]
risk factors for provoked seizures. Individuals with CKD depends on the levels of three electrolytes – sodium,
have a greater probability of seizure occurrence [9,14] . It is potassium, and calcium, and varies with extent of activation
estimated that approximately 10% of patients with advanced of ligand-gated channels and voltage-gated channels .
[19]
V
Volume 2 Issue 2 (2023) olume 2 Issue 2 (2023) 2 2 https://doi.org/10.36922/an.314
https://doi.org/10.36922/an.314