Predictors and outcome of seizures after spontaneous intracerebral hemorrhage

Abstract

Object. Seizures are an important neurological complication of spontaneous intracerebral hemorrhage (ICH).A better understanding of the risk factors of seizures following ICH is needed to predict which patients will require treatment.Methods. Two hundred and forty-three adult patients were enrolled in this 1-year retrospective study. Multiple logistic regression was used to evaluate the relationship between baseline clinical factors and the presence or absence of seizure during the study period.Results. Seizures occurred in 20 patients with ICH, including acute symptomatic seizures in 9 and unprovoked seizures in 11. None progressed to status epilepticus during hospitalization. After a minimum 3-year follow-up period, the mean Glasgow Outcome Scale score was 3.8 ± 1.1 for patients who had had seizures and 3.5 ± 1.3 for those who had not. The multiple logistic regression model demonstrated that the mean ICH volume was independently as sociated with seizures, and any increase of 1 mm 3 in ICH volume increased the seizure rate by 2.7%. Conclusions. Higher mean ICH volumes at presentation were predictive of seizure, and the presence of late seizures was predictive of developing epilepsy. Most seizures occurred within 2 years of spontaneous ICH over a minimum of 3 years of follow-up. (DOI: 10.3171/2009.2.JNS081622) KeY WorDs • outcome • risk factor • seizure • spontaneous intracerebral hemorrhage 87Abbreviations used in this paper: AED = antiepileptic drug; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICH = intracerebral hemorrhage; ROI = region of interest.

Do Early Seizures Indicate Survival of Patients with Nontraumatic Intracerebral Hemorrhage?

“…We found in this study that the occurrence of ESs seems to be correlated with cortical hemispheric hemorrhage localization. This finding is similar to the findings of other previous investigations [4,7,25] . The lobar localization of a hemorrhage has been described as a predictor of ESs following ischemic stroke and sICH owing to potential cortical involvement in comparison to deep sICH [9,26,35] .…”

“…It is difficult to compare the incidence rates of ESs reported in the literature owing to differences in the methods used, including variables like inclusion criteria, previous seizures, or time window in defining ESs. For example, several studies with a short follow-up period of 7 days reported incidence rates of ESs in patients following sICH that ranged between 1 and 12% [25][26][27] . Other studies with short follow-up periods of 24 h up to 14 days revealed incidence rates of ESs following sICH of 4-8% [6-8, 15, 28] .…”

The CAVE Score for Predicting Late Seizures After Intracerebral Hemorrhage

“…Recently presented data on patient populations similar to ours also demonstrated an association of younger age with seizures. 3,23,24 This association might reflect the higher survival of younger ICH patients. Differences in the clinical manifestation of epilepsy in elderly and younger adults can lead to underestimation of epilepsy incidence in older people.…”

“…1,[21][22][23] Despite the different design of these studies (mixed population of hemorrhagic and ischemic stroke), age below 65 years was revealed as a factor associated with seizures after ICH. Recently presented data on patient populations similar to ours also demonstrated an association of younger age with seizures.…”

“…4 Our findings agree with previous studies on larger ICH volume being predictive of LS. 23,26 It is reasonable that more extensive neuronal damage associates with higher risk of epileptogenesis.…”