Reversible Posterior Leukoencephalopathy Syndrome Presenting with Seizures

Seizures are a recognised complication in posterior reversible encephalopathy syndrome (PRES). Their management requires systematic confirmation and a structured antiseizure approach, coordinated with treatment of the underlying condition.

Clinical Scenario

Although seizures are common in patients with PRES, they have no characteristic features. Confirming their presence — ideally by electroencephalography (EEG) before initiating therapy — is a key step in this clinical scenario.

First-Line Treatment Approach

Initial seizure management in this setting begins with a benzodiazepine-based intervention. What follows, how subsequent antiseizure therapy is selected, and how to proceed when EEG is not available are covered in the full structured protocol.

Drug selection, sequencing, and the complete management algorithm are available in the protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1056/NEJMra2114482

Although seizures are common in patients with PRES, they have no characteristic features.

The presence of seizures is first confirmed by means of electroencephalography (EEG), if possible, and first-line treatment with benzodiazepines is typically followed by the addition of longer-acting antiseizure medications.

When EEG is not available, convulsions may be treated in the same way.

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