Late seizures in cerebral venous thrombosis

Abstract

Objective:To examine the incidence, characteristics, treatment, and predictors of late seizures (LS) after cerebral venous thrombosis (CVT), we described these features in a registry of 1,127 patients with CVT.Methods:We included consecutive adult patients from an international consortium of twelve hospital-based CVT registries. We excluded patients with a history of epilepsy or with <8 days of follow-up. We defined LS as seizures occurring >7 days after diagnosis of CVT. We used multivariable Cox regression to identify predictors of LS.Results:We included 1,127 patients with CVT. During a median follow-up of 2.0 years (interquartile range [IQR] 1.0-6.3), 123 patients (11%) experienced one or more LS (incidence rate for first LS 30 per 1,000 person-years, 95%CI 25-35). Median time to first LS was 5 months (IQR 1-16). Baseline predictors of LS included status epilepticus in the acute phase (Hazard Ratio [HR] 7.0, 95%CI 3.9-12.6), acute seizure(s) without status epilepticus (HR 4.1, 95%CI 2.5-6.5), intracerebral hemorrhage (HR 1.9, 95%CI 1.1-3.1), subdural hematoma (HR 2.3, 95%CI 1.1-4.9) and decompressive hemicraniectomy (HR 4.2, 95%CI 2.4-7.3). Eighty-five patients (70% of patients with LS) experienced a recurrent seizure during follow-up, despite the fact that 94% received anti-epileptic drug treatment after the first LS.Conclusion:During a median follow-up of two years, approximately one in ten patients with CVT had LS. Patients with baseline intracranial bleeding, acute symptomatic seizures, and those who underwent decompressive hemicraniectomy were at increased risk of developing LS. The high recurrence risk of LS justifies epilepsy diagnosis after a first LS.

Post‐SARS‐CoV‐2‐vaccination cerebral venous sinus thrombosis: an analysis of cases notified to the European Medicines Agency

“…Post‐vaccination CVST cases were additionally compared to a control group of CVST patients diagnosed prior to the COVID‐19 pandemic. Data for this control sample were derived from the International CVST Consortium, which is an academic collaboration established in 2015 with the aim of performing clinical research on CVST [11–14]. CVST patients from three participating European hospitals (Table S4) with symptom onset between 1 January 2015 and 31 December 2017 were used as a control sample.…”

Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not?

“…Cumulative incidence of recurrence ranges between 18% and 73% in mixed stroke cohorts after variable follow‐up, 42%‐81% in ischemic stroke cohorts, and 28%‐84% in ICH. 2 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 Long‐term survival‐adjusted risks (3‐10 years) have been reported at >70% for mixed and ischemic stroke populations (Table 2 ). One study reported 70% CI of recurrence after a remote seizure in central venous thrombosis.…”

Cerebral Venous Thrombosis: What's New?

“…45 Late seizures occur in 11% of patients, especially in patients with intracranial bleeding, acute symptomatic seizures, or who underwent decompressive hemicraniectomy. 46…”