Predictors of seizure onset after intracerebral hemorrhage and the role of long-term antiepileptic therapy
Introduction
Intracerebral hemorrhage (ICH) accounts for approximately 10% to 20% of stroke [1]. Despite best available therapy, ICH continues to cause considerable morbidity and mortality, with estimates of 30-day mortality ranging from 30% to 52%. Those patients who do survive typically have some degree of neurological disability, with only 20% regaining independence by 6 months [2]. Adding to this burden, up to one third of patients develop early- or late-onset seizures, which inhibit recovery and decrease quality of life [3], [4].
The decision to discharge patients with ICH on long-term antiepileptic medical therapy remains controversial, with recent evidence suggesting antiepileptic drugs (AEDs) may slow cognitive rehabilitation [5], [6], [7]. Despite this controversy, there are relatively few studies examining predictive factors that would allow clinicians to use medical therapy more judiciously [4], [8]. Furthermore, most investigations have focused only on early-onset seizures, occurring within 1 to 2 weeks of the initial ictus, although recent evidence suggests that early- and late-onset seizures have different etiologies. Early seizures are attributed to structural disruption and cellular biochemical dysfunction, whereas late seizures are related to gliosis and the development of meningocerebral cicatrix [9], [10]. To this end, we investigated potential predictors of both early- and late-onset seizures in surgically treated patients with ICH.
Section snippets
Study subjects
We retrospectively identified all patients with ICH who underwent clot evacuation at Columbia University Medical Center between January 1999 and November 2007 by a single surgeon (E.S.C.). Patients were included if they had a head computed tomography (CT), an operative note detailing clot evacuation, and sufficient medical records to determine clinical and demographic variables. This retrospective analysis was performed with the approval of the hospital Institutional Review Board.
Clinical management
Patients were
Results
Between January 1, 1999, and August 20, 2007, 110 patients underwent surgical evacuation for ICH. Twelve patients were excluded due to unobtainable head CT or insufficient records. The demographic and radiographic characteristics of the study population are shown in Table 1. Early-onset seizures (<14 days) occurred in 31 (31.6%) patients; late onset (>14 days) seizures occurred in 10 (10.2%) patients. A total of 29 (29.6%) seizures had clinical correlations, and 16 (16.3%) were captured on EEG.
Discussion
Seizure is a common complication after ICH that slows recovery and decreases quality of life. The decision to discharge patients with ICH on long-term antiepileptic medical therapy remains controversial, however, with recent evidence suggesting AEDs may slow cognitive rehabilitation [5], [6], [7]. Despite this controversy, there are relatively few studies examining predictive factors that would allow clinicians to use medical therapy more judiciously [4], [8]. To this end, we investigated
Acknowledgment
Matthew Garrett and Maxwell Merkow were supported by a Doris Duke Fellowship Grant.
References (15)
Intracerebral haemorrhage
Lancet
(1992)- et al.
Phenytoin increases the severity of cortical hemiplegia in rats
Brain Res
(1986) - et al.
Treatment of intracerebral haemorrhage
Lancet Neurol
(2005) - et al.
Elevated troponin levels are associated with higher mortality following intracerebral hemorrhage
Neurology
(2006) - et al.
Rehabilitation outcomes in patients with posttraumatic epilepsy
Arch Phys Med Rehabil
(1990) - et al.
Electrographic seizures and periodic discharges after intracerebral hemorrhage
Neurology
(2007) Common drugs may influence motor recovery after stroke. The sygen in acute stroke study investigators
Neurology
(1995)
Cited by (43)
Effect of Primary Prophylactic Antiseizure Medication for Seizure Prevention Following Intracerebral Hemorrhage in the ERICH Study
2022, Journal of Stroke and Cerebrovascular DiseasesA Systematic Review and Meta-Analysis of Antiepileptic Prophylaxis in Spontaneous Intracerebral Hemorrhage
2021, World NeurosurgeryCitation Excerpt :Intracerebral hemorrhage (ICH) is defined as bleeding into the brain parenchyma and accounts for 10%–15% of all cases of stroke.1 The morbidity and mortality of spontaneous intracerebral hemorrhage (sICH) are in the 20%–40% range.1,2 Seizures are a common complication in the acute setting.
Risk factors for seizures after intracerebral hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study
2020, Clinical Neurology and Neurosurgery