Seizure and status epilepticus in chronic subdural hematoma

Won, Sae‐Yeon; Dubinski, Daniel; Sautter, Lisa; Hattingen, Elke; Seifert, Volker; Rosenow, Felix; Freiman, Thomas M.; Strzelczyk, Adam; Konczalla, Juergen

doi:10.1111/ane.13131

Cited by 23 publications

(23 citation statements)

References 47 publications

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“…Neurological Research and Practice (10-16%) in those who experience primary intracerebral, subarachnoid, or subdural haemorrhage [3][4][5]. PSS treatment options, including personalised medical approaches, are currently being investigated from a variety of perspectives [6].…”

Section: Open Accessmentioning

confidence: 99%

“…However, this improvement has been accompanied by an increased prevalence and relevance of post-stroke seizures (PSS), which manifest in approximately 5–7% of ischaemic stroke survivors each year [ 1 , 2 ] and can worsen post-stroke prognosis. The PSS risk is higher (10–16%) in those who experience primary intracerebral, subarachnoid, or subdural haemorrhage [ 3 – 5 ]. PSS treatment options, including personalised medical approaches, are currently being investigated from a variety of perspectives [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Seizures and epilepsy in patients with ischaemic stroke

Zöllner

Schmitt

Rosenow

et al. 2021

Neurol. Res. Pract.

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Background With the increased efficacy of stroke treatments, diagnosis and specific treatment needs of patients with post-stroke seizures (PSS) and post-stroke epilepsy have become increasingly important. PSS can complicate the diagnosis of a stroke and the treatment of stroke patients, and can worsen post-stroke morbidity. This narrative review considers current treatment guidelines, the specifics of antiseizure treatment in stroke patients as well as the state-of-the-art in clinical and imaging research of post-stroke epilepsy. Treatment of PSS needs to consider indications for antiseizure medication treatment as well as individual clinical and social factors. Furthermore, potential interactions between stroke and antiseizure treatments must be carefully considered. The relationship between acute recanalizing stroke therapy (intravenous thrombolysis and mechanical thrombectomy) and the emergence of PSS is currently the subject of an intensive discussion. In the subacute and chronic post-stroke phases, important specific interactions between necessary antiseizure and stroke treatments (anticoagulation, cardiac medication) need to be considered. Among all forms of prevention, primary prevention is currently the most intensively researched. This includes specifically the repurposing of drugs that were not originally developed for antiseizure properties, such as statins. PSS are presently the subject of extensive basic clinical research. Of specific interest are the role of post-stroke excitotoxicity and blood–brain barrier disruption for the emergence of PSS in the acute symptomatic as well as late (> 1 week after the stroke) periods. Current magnetic resonance imaging research focussing on glutamate excitotoxicity as well as diffusion-based estimation of blood–brain barrier integrity aim to elucidate the pathophysiology of seizures after stroke and the principles of epileptogenesis in structural epilepsy in general. These approaches may also reveal new imaging-based biomarkers for prediction of PSS and post-stroke epilepsy. Conclusion PSS require the performance of individual risk assessments, accounting for the potential effectiveness and side effects of antiseizure therapy. The use of intravenous thrombolysis and mechanical thrombectomy is not associated with an increased risk of PSS. Advances in stroke imaging may reveal biomarkers for PSS.

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Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Seizures and epilepsy in patients with ischaemic stroke

Zöllner

Schmitt

Rosenow

et al. 2021

Neurol. Res. Pract.

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“…Previous studies have reported that the perioperative period of CSDH may be secondary to epilepsy. 34 However, whether it is correlated with recurrence was not validated.…”

Section: Discussionmentioning

confidence: 99%

Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses

Zhu

Wang

et al. 2022

eClinicalMedicine

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Summary Background Chronic subdural hematoma (CSDH) is a common neurological disease, and the surgical evacuation of subdural collection remains the primary treatment approach for symptomatic patients. Postoperative recurrence is a serious complication, and several factors are correlated with postoperative recurrence. Methods We searched Embase, Web of Science, PubMed, and Cochrane Library from their establishment to September 2020. Reports on randomized, prospective, retrospective, and overall observational studies on the management of surgical patients with CSDH were searched, and an independent reviewer performed research quality assessment. Factors that affect the postoperative recurrence of CSDH were extracted: social demographics, drugs (as the main or auxiliary treatment), surgical management, imaging, and other risk factors. We evaluated the recurrence rate of each risk factor. A random effect model was used to perform a meta-analysis, and each risk factor affecting the postoperative recurrence of CSDH was then evaluated and graded. Findings In total, 402 studies were included in this analysis and 32 potential risk factors were evaluated. Among these, 21 were significantly associated with the postoperative recurrence of CSDH. Three risk factors (male, bilateral hematoma, and no drainage) had convincing evidence. The classification of evidence can help clinicians identify significant risk factors for the postoperative recurrence of CSDH. Interpretation Only few associations were supported by high-quality evidence. Factors with high-quality evidence may be important for treating and preventing CSDH recurrence. Our results can be used as a basis for improving clinical treatment strategies and designing preventive methods. Funding No funding was received.

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“…Furthermore, previous studies had less precise measures of outcome: one study only defined outcome as good recovery, no change, worse or dead, without clear descriptions of the groups, and the other only concluded that unfavorable outcome (mRS 3-6 vs. 0-2) is more often present in patients with seizures. 4,16 Also, and possibly of most importance is that they also included patients with postoperative seizures, which have a different pathophysiology and therefore possibly other implications for outcome. 16 This might also explain the higher prevalence of seizures in their study compared to ours (15% vs. 2%).…”

Section: Discussionmentioning

confidence: 99%

“…The relationship between presenting symptoms and functional outcome has been clearly established in acute traumatic brain injury and stroke, but such data are scarce for CSDH patients 9–12 . Studies that have assessed the association between signs on admission and outcome in CSDH focused on seizures and decreased consciousness as presenting signs 4,13–16 . These studies revealed that patients with CSDH and seizures or low Glasgow coma Scale (GCS) scores have a worse outcome.…”

Section: Introductionmentioning

confidence: 99%

Presenting symptoms and functional outcome of chronic subdural hematoma patients

Blaauw

Meelis

Jacobs

et al. 2021

Acta Neuro Scandinavica

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Background: Patients with chronic subdural hematoma (CSDH) can present with a variety of signs and symptoms. The relationship of these signs and symptoms with functional outcome is unknown. Knowledge of these associations might aid clinicians in the choice to initiate treatment and may allow them to better inform patients on expected outcomes.Objective: To investigate if presenting signs and symptoms influence functional outcome in patients with CSDH. Methods:We conducted a retrospective analysis of consecutive CSDH patients in three hospitals. Glasgow Outcome Scale Extended (GOS-E) scores were obtained from the first follow-up visit after treatment. An ordinal multivariable regression analysis was performed, to assess the relationship between the different signs and symptoms on the one hand and functional outcome on the other adjusted for potential confounders. Results:We included 1,307 patients, of whom 958 (73%) were male and mean age was 74 (SD ± 11) years. Cognitive complaints were associated with lower GOS-E scores at follow-up (aOR 0.7, 95% CI: 0.5 -0.8) Headache and higher Glasgow Coma Scale (GCS) scores were associated with higher GOS-E scores. (aOR 1.9, 95% CI: 1.5-2.3 and aOR 1.3, 95% CI: 1.2-1.4). Conclusion:Cognitive complaints are independently associated with worse functional outcome, whereas headache and higher GCS scores are associated with better outcome. The increased probability of unfavorable outcome in patients with CSDH who present with cognitive complaints favors a more prominent place of assessing cognitive status at diagnosis.

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Seizure and status epilepticus in chronic subdural hematoma

Cited by 23 publications

References 47 publications

Seizures and epilepsy in patients with ischaemic stroke

Seizures and epilepsy in patients with ischaemic stroke

Factors correlated with the postoperative recurrence of chronic subdural hematoma: An umbrella study of systematic reviews and meta-analyses

Presenting symptoms and functional outcome of chronic subdural hematoma patients

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