Not every seizure necessarily means a diagnosis of epilepsy. When a seizure occurs in direct temporal relation to an acute insult to the central nervous system (CNS), it is classified as an acute symptomatic seizure. These seizures typically do not recur once the underlying cause has resolved or been treated.
ASS are relatively common and account for approximately 40% of all first-time seizures. When a primary condition—such as a stroke—is complicated by the occurrence of acute symptomatic seizures, it often indicates a worse overall prognosis for the patient.
Acute symptomatic seizures can occur at any age, much like epilepsy itself.
- In young children, ASS are most commonly triggered by CNS infections or head trauma.
- In adults around age 40, seizures often result from withdrawal from alcohol or other substances.
- In older adults, metabolic causes become more prominent.
The four most common causes of ASS – cerebrovascular events, head trauma, CNS infections and substance withdrawal account for about 60% of all ASS cases. Other notable causes include metabolic disturbances (approximately 10%) and toxic causes, including drug intoxications (around 6%).
The average risk of developing epilepsy after experiencing acute symptomatic seizures is around 20%, though this varies significantly depending on the cause. The highest risk is seen in patients who experienced ASS following a stroke, with the likelihood of developing epilepsy reaching 30% in these cases.
ASS Related to Substance Use
In the Czech Republic, acute symptomatic seizures related to harmful alcohol use are among the most frequently observed. Up to one-third of hospital admissions for seizures are associated with ASS triggered by excessive alcohol consumption. In individuals with alcohol dependence, seizures typically occur 24 to 48 hours after alcohol withdrawal and may be accompanied by other withdrawal symptoms such as tremors, sweating, rapid heartbeat, and delirium.
ASS can also occur in the setting of acute alcohol intoxication, when blood alcohol levels are extremely high. However, it’s important to note that in up to 50% of cases initially attributed to alcohol, a different underlying cause is eventually identified.
More recently, acute symptomatic seizures related to kratom abuse have been reported, especially in children and young adults.
Driving After an Acute Symptomatic Seizure
Medical fitness to drive after an ASS is regulated by Decree No. 277/2004 Coll.
An acute symptomatic seizure does not automatically restrict driving for personal or professional use (licenses A and B), nor for other license categories, provided that the likelihood of recurrence while driving is low. For professional drivers, the annual risk of recurrence must be less than 2%.
It is also essential to consider the underlying condition that caused the seizure. For example, a patient who experiences an ASS due to uncontrolled diabetes may not be restricted from driving from a neurological standpoint, but their driver’s license may be revoked on the recommendation of a diabetologist.