Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage

Rhoney, Denise H.; Tipps, Lia B.; Murry, Kellie R.; Basham, M.C.; Michael, D.B.; Coplin, William M.

doi:10.1212/wnl.55.2.258

Cited by 158 publications

(133 citation statements)

References 35 publications

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“…In our study the median starting time for cEEG registration was 42 hours after admittance, which is well within the range reported by other authors [1,11,15,17].…”

Section: Discussionsupporting

confidence: 91%

“…In contrast to the reports on the occurrence of subclinical seizures in head trauma, which have mostly been reported to occur relatively early after trauma, the majority of the reports on subclinical seizures in SAH patients report a later onset of seizures [17,23,28]. In our study the median starting time for cEEG registration was 42 hours after admittance, which is well within the range reported by other authors [1,11,15,17].…”

Section: Discussionsupporting

confidence: 80%

“…This number of reported early seizures is high compared with the literature, but the reliability of the reporting of seizures outside the hospital by paramedics could be questioned [17,18].…”

Section: Discussionmentioning

confidence: 82%

“…Clinical seizures are common in patients suffering from subarachnoid haemorrhage (SAH). The seizures can occur at the onset of the bleeding or during the acute treatment period [16][17][18]. Early clinical seizures have often been associated with re-bleeding, and as the frequency of re-bleeding have declined in recent years, due to more aggressive treatment and early surgical intervention, the number of clinical seizures overall among SAH patients have decreased.…”

Section: Introductionmentioning

confidence: 99%

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Frequency of Non-convulsive Seizures and Non-convulsive Status Epilepticus in Subarachnoid Hemorrhage Patients in Need of Controlled Ventilation and Sedation

et al. 2012

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Frequency of non-convulsive Seizures and non-convulsive status Epilepticus in SubarachnoidHemorrhage patients in need of controlled ventilation and sedation. Umeå UniversityThis is an accepted version of a paper published in Neurocritical Care. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.Citation for the published paper: Lindgren, C., Nordh, E., Naredi, S., Olivecrona, M. (2012 AbstractBackground: Non-convulsive seizures (NCSZ) can be more prevalent than previously recognized among comatose neuro-intensive care patients. The aim of this study was to evaluate the frequency of NCSZ and non-convulsive status epilepticus (NCSE) in sedated and ventilated subarachnoid haemorrhage (SAH) patients. Methods: Retrospective study at a university hospital neuro-intensive care unit, from January 2008 until June 2010. Patients were treated according to a local protocol, and were initially sedated with midazolam or propofol or combinations of these sedative agents. Thiopental was added for treatment of intracranial hypertension. No wake-up tests were performed. Using NicoletOne® equipment (VIASYS Healthcare Inc., U.S.A.), continuous EEG recordings based on four electrodes and a reference electrode was inspected at full length both in a two electrode bipolar and a four channel referential montage.Results: Approximately 5500 hours of continuous EEG were registered in 28 SAH patients (33% of the patients eligible for inclusion). The median Glasgow Coma scale was 8 (range 3-14) and the median Hunt & Hess score was 4 (range 1-4). During EEG registration no clinical seizures were observed. In none of the patients inter ictal epileptiform activity was seen. EEG seizures were recorded only in 2/28 (7%) patients. One of the patients experienced four minutes of a NCSZ and one had a five hours episode of a NCSE. Conclusion: Continuous EEG monitoring is important in detecting non-convulsive seizures in sedated patients. Continuous sedation, without wake-up tests, was associated with a low frequency of subclinical seizures in SAH patients in need of controlled ventilation.

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“…In our study the median starting time for cEEG registration was 42 hours after admittance, which is well within the range reported by other authors [1,11,15,17].…”

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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Frequency of Non-convulsive Seizures and Non-convulsive Status Epilepticus in Subarachnoid Hemorrhage Patients in Need of Controlled Ventilation and Sedation

et al. 2012

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confidence: 99%

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Fung¹,

Balmer²,

Murek³

et al. 2015

JNS

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O n presentation at a neurosurgical-neurovascular center, patients suffering from aneurysmal subarachnoid hemorrhage (SAH) may exhibit a reduced level of consciousness due to initial bleeding, rebleeding, hydrocephalus, sedation, or seizure 1,9,15,20,22 as well as other conditions. Subarachnoid hemorrhage causes seizures in up to 26% of patients, which occur most commonly within the first 24 hours. 3,9,20,23 Most seizures occur before hospital presentation. 20 The severity of SAH, as graded on scales like the World Federation of Neurosurgical Societies (WFNS) scale, as well as intracerebral hemorrhage (ICH), localization of the aneurysm, and the amount of subarachnoid blood are important risk factors for the development of early seizures. obJect After subarachnoid hemorrhage (SAH), seizure occurs in up to 26% of patients. The impact of seizure on outcome has been studied, yet its impact on grading is unknown. The authors evaluated the impact of early-onset seizures (EOS) on grading of spontaneous SAH and on outcome. methods This retrospective analysis included consecutive patients with SAH who were treated at the NeuroCenter, Inselspital, University Hospital Bern, Switzerland, between January 2005 and December 2010. Demographic data, clinical data, and reports of EOS were recorded. The EOS were defined as seizures occurring within 24 hours after ictus. Patients were graded according to the World Federation of Neurosurgical Societies (WFNS) scale pre- and postresuscitation and dichotomized into good (WFNS I-III) and poor (WFNS IV-V) grades. Outcome was assessed at 6 months by using the modified Rankin Scale (mRS); an mRS score of 0-3 was considered a good outcome and an mRS score of 4-6 was considered a poor outcome. results Forty-one of 425 patients with SAH had EOS. Twenty-seven of those 41 patients (65.9%) had a poor WFNS grade. Twenty-eight (68.3%) achieved a good outcome, 11 (26.8%) had a poor outcome, and 2 (4.9%) were lost to followup. Early-onset seizures were proven in 9 of 16 electroencephalograms. The EOS were associated with poor WFNS grade (OR 2.81, 97.5% CI 1.14-7.46; p = 0.03) and good outcome (OR 4.01, 97.5% CI 1.63-10.53; p = 0.03). Increasing age, hydrocephalus, intracerebral hemorrhage, and intraventricular hemorrhage were associated with poor WFNS grade, whereas only age, intracerebral hemorrhage (p < 0.001), and poor WFNS grade (p < 0.001) were associated with poor outcome. coNclusioNs Patients with EOS were classified significantly more often in a poor grade initially, but then they significantly more often achieved a good outcome. The authors conclude that EOS can negatively influence grading. This might influence decision making for the care of patients with SAH, so grading of patients with EOS should be interpreted with caution.

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Poststroke Seizures

Silverman¹,

Restrepo²,

Mathews³

2002

Arch Neurol

239

172

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Stroke is the most common cause of seizures in the elderly, and seizures are among the most common neurologic sequelae of stroke. About 10% of all stroke patients experience seizures, from stroke onset until several years later. This review discusses current understanding of the epidemiology, pathogenesis, classification, clinical manifestations, diagnostic studies, differential diagnosis, and management issues of seizures associated with various cerebrovascular lesions, with a focus on anticonvulsant use in the elderly.

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Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage

Cited by 158 publications

References 35 publications

Frequency of Non-convulsive Seizures and Non-convulsive Status Epilepticus in Subarachnoid Hemorrhage Patients in Need of Controlled Ventilation and Sedation

Frequency of Non-convulsive Seizures and Non-convulsive Status Epilepticus in Subarachnoid Hemorrhage Patients in Need of Controlled Ventilation and Sedation

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Poststroke Seizures

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