Seizures after primary intracerebral hemorrhage

Abstract

We followed 123 patients with primary intracerebral hemorrhage (ICH), defined as bleeding without known precipitating cause except hypertension, for an average of 4.6 years or until death in order to determine the incidence, prevalence, and type of epileptic seizures. Twenty-five percent had seizures. In one-half of these, the seizures began within 24 hours of the hemorrhage. Survival table analysis predicted a potential cumulative seizure incidence of 50%, had all patients survived 5 years. Seizure incidence was high with bleeding into lobar cortical structures (54%), low with basal ganglionic hemorrhages (19%), and zero with thalamic hemorrhages. Within the basal ganglia, caudate involvement predicted seizures; within the cortex, temporal or parietal involvement predicted seizures. Although seizure incidence was high, prevalence of chronic epilepsy was much lower: 13% in 30-day to 2-year survivors and 6.5% in 2- to 5-year survivors. Seizure incidence is higher than previously reported after ICH because small lobar hemorrhages are the most epileptogenic and are now easily recognized with computed tomography.

The CAVE Score for Predicting Late Seizures After Intracerebral Hemorrhage

“…Data from a recent study suggest blood-brain barrier dysfunction and accumulation of albumin within astrocytes as new pathological features potentially associated with the epileptogenic mechanism of vascular lesions. 27 In contrast to previous series, 5,28 we found early seizures to be associated with the risk of developing LS. This discrepancy could be because of our larger sample size (n=764) compared with the 2 previous studies (n=123 28 and n=325 5 ).…”

“…27 In contrast to previous series, 5,28 we found early seizures to be associated with the risk of developing LS. This discrepancy could be because of our larger sample size (n=764) compared with the 2 previous studies (n=123 28 and n=325 5 ). In the study by Rossi et al, 5 early seizures were more common in patients who developed LS (26%) compared with those who did not (15%), although not statistically significant (P=0.10).…”

Predictors and outcome of seizures after spontaneous intracerebral hemorrhage

“…Thus, there was continued uncertainty in assessing the incidence of chronic epilepsy/unprovoked seizures after spontaneous ICH in nonselected patients Several authors have reported variables related to seizures after spontaneous ICH. 4,3,9,14,15,19,22 Cerebral hemorrhages giving rise to seizures were predominantly cortical in location, 3,10,16,19,22 although two-thirds of seizures arose from deep cerebral hemorrhages in our study (in 12 patients), a figure lower than previous studies. 3,19,22 Our study demonstrated that presence of cortical hemorrhage was predictive of seizures.…”

“…The results of previous studies have demonstrated that large cerebral hemorrhages do not cause seizures, although the associated neurological deficits are more severe, and seizures are not associated with clinical deterioration in patients with cerebral hemorrhage. 10,16 The utility of prophylactic AED therapy in the prevention of seizures in patients with ICH remains unclear, 3,4,10,18 although a possible benefit is the reduction in functional complications from seizures following spontaneous ICH. However, uncertainty exists regarding the need for and best choice of drug, proper dosing, and duration of treatment after spontaneous ICH.…”

Anticonvulsant Use and Outcomes After Intracerebral Hemorrhage

“…Seizures were less common than in many series, which likely reduced any potential benefits of prophylactic AED use. Future research might clarify protocols for the effective use and reporting of EEG monitoring, target specific populations at high risk for seizures after ICH (eg, lobar hemorrhage 5,25 with depressed mental status), and examine protocols to minimize AED exposure in patients unlikely to benefit from therapy.…”