Mortality after primary intracerebral hemorrhage in relation to post-stroke seizures

Claessens, Danny; Bekelaar, Kim; Schreuder, Floris H.B.M.; Greef, Bianca T A de; Vlooswijk, Mariëlle C.G.; Staals, Julie; Oostenbrugge, Robert J. van; Rouhl, Rob P.W.

doi:10.1007/s00415-017-8573-1

Cited by 24 publications

(29 citation statements)

References 26 publications

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“…As reported above, this study is limited because it enrolled only patients aged 18 to 50 years [25]. On the contrary, Claessens et al observed that seizures after ICH were not significantly related to mortality risk after follow-up up to 10 years [23]. Our results agree with this last survey.…”

Section: Discussionsupporting

confidence: 89%

“…Recently, Claessens et al conducted a retrospective study to explore a possible association between post-stroke seizures and long-term mortality. After correction for possible confounding variables, the authors concluded that seizures were not significantly related to mortality risk [23]. Conversely, in the prospective Future study, Arntz et al showed that post-stroke seizures negatively affect long-term disability and mortality [24,25].…”

Section: Introductionmentioning

confidence: 99%

“…Differences in the population study might explain these conflicting findings. In particular, Claessens et al included only patients with intracerebral hemorrhage (ICH), whereas Arntz et al included only young patients, aged 18 to 50 years, after transient ischemic attack (TIA), ischemic stroke (IS) or ICH [23,24,25]. Bearing in mind that ICH accounts for almost 15% of all strokes and that cerebrovascular accidents are largely more common in subjects older than 50 years, these results cannot be directly generalizable to all stroke patients.…”

Section: Introductionmentioning

confidence: 99%

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Seizures Do Not Affect Disability and Mortality Outcomes of Stroke: A Population-Based Study

Merlino

Gigli

Bax

et al. 2019

JCM

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Although seizures are frequently seen after cerebrovascular accidents, their effects on long-term outcome in stroke patients are still unknown. Therefore, the aim of this study was to investigate the relationship between post-stroke seizures and the risk of long-term disability and mortality in stroke patients. This study is part of a larger population-based study. All patients were prospectively followed up by a face-to-face interview or a structured telephone interview. We enrolled 635 patients with first-ever stroke and without a history of seizures. Prevalence of ischemic stroke (IS) was 85.2%, while the remaining 14.8% of patients were affected by intracerebral hemorrhage (ICH). During the study period, 51 subjects (8%) developed post-stroke seizures. Patients with post-stroke seizures were younger, had a higher prevalence of ICH, had a more severe stroke at admission, were more likely to have an IS involving the total anterior circulation, and were more likely to have a lobar ICH than patients without seizures. Moreover, subjects with seizures had more frequently hemorrhagic transformation after IS and cortical strokes. At 24 months, the risk of disability in patients with seizures was almost twice than in those without seizures. However, the negative effect of seizures disappeared in multivariate analysis. Kaplan-Meier survival curves at 12 years were not significantly different between patients with and without post-stroke seizures. Using the Cox multivariate analysis, age, NIHSS at admission, and pre-stroke mRS were independently associated with all-cause long-term mortality. In our sample, seizures did not impair long-term outcome in patients affected by cerebrovascular accidents. The not significant, slight difference in favor of a better survival for patients with seizures may be attributed to the slight age difference between the two groups.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Seizures Do Not Affect Disability and Mortality Outcomes of Stroke: A Population-Based Study

Merlino

Gigli

Bax

et al. 2019

JCM

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“…7,8 Our 10-year survival rate was very similar to the one reported in a population-based study that enrolled 7-day ICH survivors (38% vs. 37%, respectively). 21 In another population-based study with significant methodological differences, 10-year survival rate was slightly lower (24.1%). 22 Only one population-based study that collected data of 28-day ICH survivors of (enrolment period 1985–1991) reported a follow-up data longer than 10 years.…”

Section: Discussionmentioning

confidence: 92%

Long-term mortality in survivors of spontaneous intracerebral hemorrhage

Pasi

Casolla

Kyheng

et al. 2020

International Journal of Stroke

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Background Factors associated with long-term mortality after spontaneous intracerebral hemorrhage (ICH) have been poorly investigated. Aim Our objective was to identify variables associated with long-term mortality in a prospective cohort of 30-day ICH survivors. Methods We prospectively included consecutive 30-day spontaneous ICH survivors. We evaluated baseline and follow-up clinical characteristics and magnetic resonance imaging (MRI) markers of chronic brain injury as variables associated with long-term mortality using univariate and multivariable Cox proportional hazard regression models. Results Of 560 patients with spontaneous ICH, 304 (54.2%) survived more than 30 days and consented for follow-up. During a median follow-up of 10 years (interquartile range: 8.0–10.5), 176 patients died. The cumulative survival rate at 10 years was 38%. In multivariable analysis, variables independently associated with long-term mortality were age (hazard ratio (HR) per 10-year increase: 1.68, 95% confidence interval (CI): 1.45–1.95), male gender (HR: 1.41, CI: 1.02–1.95), prestroke dependency (HR: 1.66, CI: 1.15–2.39), National Institutes of Health Stroke Scale score (HR per 1-point increase: 1.03, CI: 1.01–1.04), occurrence of any stroke (HR: 2.24, CI: 1.39–3.60), and dementia (HR: 1.51, CI: 1.06–2.16) during follow-up. Among MRI markers, only cerebral atrophy (HR per 1-point increase: 1.50, CI: 1.13–2.00) was independently associated with long-term mortality. Conclusions Preexisting comorbidities, clinical severity at presentation, and significant clinical event during follow-up are associated with long-term mortality. Among MRI markers of chronic brain injury, only cerebral atrophy is associated with long-term mortality.

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“…Consequently, Jo et al reported that nanoscale iron injection into the adult mouse cortex leads to a reduction in the number of GABAergic interneurons [ 6 ]. The rate of seizures after intracranial hemorrhage has been reported to be around 10–15% for intracerebral hemorrhage and 10–20% for subarachnoid hemorrhage, respectively [ 1 , 4 , 5 ]. In cases of traumatic brain injury, mechanisms including neuroinflammation, tauopathy, and mediation by toll-like receptors are discussed to cause seizures in 10–20% of patients [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

New-onset seizures after cranioplasty—a different view on a putatively frequently observed phenomenon

et al. 2021

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Background New-onset seizures after cranioplasty (NOSAC) are reported to be a frequent complication of cranioplasty (CP) after decompressive hemicraniectomy (DHC). There are considerable differences in the incidence of NOSAC and contradictory data about presumed risk factors in the literature. We suggest NOSAC to be a consequence of patients’ initial condition which led to DHC, rather than a complication of subsequent CP. We conducted a retrospective analysis to verify our hypothesis. Methods The medical records of all patients ≥ 18 years who underwent CP between 2002 and 2017 at our institution were evaluated including incidence of seizures, time of seizure onset, and presumed risk factors. Indication for DHC, type of implant used, timing of CP, patient age, presence of a ventriculoperitoneal shunt (VP shunt), and postoperative complications were compared between patients with and without NOSAC. Results A total of 302 patients underwent CP between 2002 and 2017, 276 of whom were included in the outcome analysis and the incidence of NOSAC was 23.2%. Although time between DHC and CP differed significantly between DHC indication groups, time between DHC and seizure onset did not differ, suggesting the occurrence of seizures to be independent of the procedure of CP. Time of follow-up was the only factor associated with the occurrence of NOSAC. Conclusion New-onset seizures may be a consequence of the initial condition leading to DHC rather than of CP itself. Time of follow-up seems to play a major role in detection of new-onset seizures.

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Mortality after primary intracerebral hemorrhage in relation to post-stroke seizures

Cited by 24 publications

References 26 publications

Seizures Do Not Affect Disability and Mortality Outcomes of Stroke: A Population-Based Study

Seizures Do Not Affect Disability and Mortality Outcomes of Stroke: A Population-Based Study

Long-term mortality in survivors of spontaneous intracerebral hemorrhage

New-onset seizures after cranioplasty—a different view on a putatively frequently observed phenomenon

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