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Ha WS, Jang K, Cho S, Kim WJ, Chu MK, Heo K, Kim KM. Risk Factors and Temporal Patterns of Poststroke Epilepsy across Stroke Subtypes: Insights from a Nationwide Cohort Study in Korea. Neuroepidemiology 2024:1-11. [PMID: 38599180 DOI: 10.1159/000538776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION We aimed to investigate the risk factors associated with poststroke epilepsy (PSE) among patients with different subtypes of stroke, focusing on age-related risk and time-varying effects of stroke subtypes on PSE development. METHODS A retrospective, nationwide, population-based cohort study was conducted using Korean National Health Insurance Service-National Sample Cohort data. Patients hospitalized with newly diagnosed stroke from 2005 to 2015 were included and followed up for up to 10 years. The primary outcome was the development of PSE, defined as having a diagnostic code and a prescription for anti-seizure medication. Multivariable Cox proportional hazard models were used to estimate PSE hazard ratios (HRs), and time-varying effects were also assessed. RESULTS A total of 8,305 patients with ischemic stroke, 1,563 with intracerebral hemorrhage (ICH), and 931 with subarachnoid hemorrhage (SAH) were included. During 10 years of follow-up, 4.6% of patients developed PSE. Among patients with ischemic stroke, significant risk factors for PSE were younger age (HR = 1.47), living in rural areas (HR = 1.35), admission through the emergency room (HR = 1.33), and longer duration of hospital stay (HR = 1.45). Time-varying analysis revealed elevated HRs for ICH and SAH, particularly in the first 2 years following the stroke. The age-specific HRs also showed an increased risk for those under the age of 65, with a noticeable decrease in risk beyond that age. CONCLUSION The risk of developing PSE varies according to stroke subtype, age, and other demographic factors. These findings underscore the importance of tailored poststroke monitoring and management strategies to mitigate the risk of PSE.
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Affiliation(s)
- Woo-Seok Ha
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kimoon Jang
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Misra S, Kasner SE, Dawson J, Tanaka T, Zhao Y, Zaveri HP, Eldem E, Vazquez J, Silva LS, Mohidat S, Hickman LB, Khan EI, Funaro MC, Nicolo JP, Mazumder R, Yasuda CL, Sunnerhagen KS, Ihara M, Ross JS, Liebeskind DS, Kwan P, Quinn TJ, Engel J, Mishra NK. Outcomes in Patients With Poststroke Seizures: A Systematic Review and Meta-Analysis. JAMA Neurol 2023; 80:1155-1165. [PMID: 37721736 PMCID: PMC10507596 DOI: 10.1001/jamaneurol.2023.3240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/21/2023] [Indexed: 09/19/2023]
Abstract
Importance Published data about the impact of poststroke seizures (PSSs) on the outcomes of patients with stroke are inconsistent and have not been systematically evaluated, to the authors' knowledge. Objective To investigate outcomes in people with PSS compared with people without PSS. Data Sources MEDLINE, Embase, PsycInfo, Cochrane, LILACS, LIPECS, and Web of Science, with years searched from 1951 to January 30, 2023. Study Selection Observational studies that reported PSS outcomes. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for abstracting data, and the Joanna Briggs Institute tool was used for risk-of-bias assessment. Data were reported as odds ratio (OR) and standardized mean difference (SMD) with a 95% CI using a random-effects meta-analysis. Publication bias was assessed using funnel plots and the Egger test. Outlier and meta-regression analyses were performed to explore the source of heterogeneity. Data were analyzed from November 2022 to January 2023. Main Outcomes and Measures Measured outcomes were mortality, poor functional outcome (modified Rankin scale [mRS] score 3-6), disability (mean mRS score), recurrent stroke, and dementia at patient follow-up. Results The search yielded 71 eligible articles, including 20 110 patients with PSS and 1 166 085 patients without PSS. Of the participants with PSS, 1967 (9.8%) had early seizures, and 10 605 (52.7%) had late seizures. The risk of bias was high in 5 studies (7.0%), moderate in 35 (49.3%), and low in 31 (43.7%). PSSs were associated with mortality risk (OR, 2.1; 95% CI, 1.8-2.4), poor functional outcome (OR, 2.2; 95% CI, 1.8-2.8), greater disability (SMD, 0.6; 95% CI, 0.4-0.7), and increased dementia risk (OR, 3.1; 95% CI, 1.3-7.7) compared with patients without PSS. In subgroup analyses, early seizures but not late seizures were associated with mortality (OR, 2.4; 95% CI, 1.9-2.9 vs OR, 1.2; 95% CI, 0.8-2.0) and both ischemic and hemorrhagic stroke subtypes were associated with mortality (OR, 2.2; 95% CI, 1.8-2.7 vs OR, 1.4; 95% CI, 1.0-1.8). In addition, early and late seizures (OR, 2.4; 95% CI, 1.6-3.4 vs OR, 2.7; 95% CI, 1.8-4.1) and stroke subtypes were associated with poor outcomes (OR, 2.6; 95% CI, 1.9-3.7 vs OR, 1.9; 95% CI, 1.0-3.6). Conclusions and Relevance Results of this systematic review and meta-analysis suggest that PSSs were associated with significantly increased mortality and severe disability in patients with history of stroke. Unraveling these associations is a high clinical and research priority. Trials of interventions to prevent seizures may be warranted.
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Affiliation(s)
- Shubham Misra
- Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yize Zhao
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Hitten P. Zaveri
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Ece Eldem
- Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Juan Vazquez
- Albert Einstein College of Medicine, Bronx, New York
| | - Lucas Scárdua Silva
- Department of Neurology, School of Medical Sciences, University of Campinas-UNICAMP, Sao Paulo, Brazil
| | - Saba Mohidat
- The University of Melbourne, Melbourne, Victoria, Australia
| | - L. Brian Hickman
- Department of Neurology, The University of California, Los Angeles
| | - Erum I. Khan
- Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
- Alzheimer’s Disease Research Center, University of Alabama, Birmingham
| | - Melissa C. Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - John-Paul Nicolo
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | | | - Clarissa Lin Yasuda
- Department of Neurology, School of Medical Sciences, University of Campinas-UNICAMP, Sao Paulo, Brazil
| | | | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Joseph S. Ross
- Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Patrick Kwan
- The AIM for Health, Faculty of IT, Monash University, Melbourne, Victoria, Australia
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Jerome Engel
- Department of Neurology, The University of California, Los Angeles
| | - Nishant K. Mishra
- Division of Stroke & Vascular Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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Lin J, Li X, Ye J, Li G, Huang S, Zhu S. External validation and comparison of clinical scores for predicting late seizures after intracerebral hemorrhage in Chinese patients. Epilepsy Behav 2023; 145:109349. [PMID: 37441984 DOI: 10.1016/j.yebeh.2023.109349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/13/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE Clinical scores have been established to predict the probability of late seizures following intracerebral hemorrhage (ICH) for individual patients, including the CAVE, CAVS and LANE scores. The purpose of this study was to compare these prediction scores in the Chinese population and undertake an independent external validation on them. METHODS At one tertiary hospital in China, we retrospectively recruited consecutive inpatients who had been diagnosed with ICH. Medical records and tele interviews with a modified standardized questionnaire were used to identify late seizures. All the predictors of the prediction scores were collected from patient charts and databases by a standardized data collection protocol. The external validation of the prediction scores was quantified by the area under the curve (AUC), sensitivity, specificity, Youden index (YI), positive predictive value (PPV), and negative predictive value (NPV). RESULTS 69 (5.4%) of 1276 patients experienced late seizures after ICH. There was no significant difference in the CAVE, CAVS, and LANE scores, which had AUCs of 0.75 (95% CI = 0.70-0.81), 0.74 (95% CI = 0.68-0.80), and 0.76 (95% CI = 0.70-0.82), respectively. At the optimal cutoff score, the LANE score had a lower sensitivity but a higher specificity than the CAVE and CAVS scores. Among the three prediction scores, the LANE score had a higher PPV than the others (0.145 vs. 0.088, 0.083), while the NPV was similar among the three prediction scores (0.989, 0.989, and 0.972). CONCLUSION Our study showed that the CAVE, CAVS and LANE scores had similar AUCs for the occurrence of late seizures, but the LANE score had a relatively high PPV at the optimal cutoff score. Due to low evidence for using prophylactic antiseizure medications (ASM) in patients with ICH and poor availability of specialist stroke care in China, the LANE score with a cutoff score of 3 could be an applicable prediction tool in Chinese patients with ICH.
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Affiliation(s)
- Jiahe Lin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianxian Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahe Ye
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Lin J, Lin R, Li X, Ye J, Wang Y, Zhang B, Chen X, Wang X, Huang S, Zhu S. Association between minimally invasive surgery and late seizures in patients with intracerebral hemorrhage: A propensity score matching study. Front Surg 2022; 9:949804. [PMID: 36311938 PMCID: PMC9606625 DOI: 10.3389/fsurg.2022.949804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The association between minimally invasive surgery (MIS) for hematoma evacuation and late seizures after intracerebral hemorrhage (ICH) remains uncertain. We aimed to investigate whether MIS increases the risk of late seizures after ICH and identify the risk factors for late seizures in this patient subgroup. Methods We retrospectively included consecutive inpatients diagnosed with ICH at two tertiary hospitals in China. The subjects were divided into the MIS group (ICH patients who received MIS including hematoma aspiration and thrombolysis) and conservative treatment group (ICH patients who received conservative medication). Propensity score matching was performed to balance possible risk factors for late seizures between the MIS and conservative treatment groups. Before and after matching, between-group comparisons of the incidence of late seizures were performed between the MIS and conservative treatment groups. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for late seizures in MIS-treated patients. Results A total of 241 and 1,689 patients were eligible for the MIS and conservative treatment groups, respectively. After matching, 161 ICH patients from the MIS group were successfully matched with 161 ICH patients from the conservative treatment group (1:1). Significant differences (p < 0.001) were found between the MIS group (31/241, 12.9%) and conservative treatment group (69/1689, 4.1%) in the incidence of late seizures before matching. However, after matching, no significant differences (p = 0.854) were found between the MIS group (17/161, 10.6%) and conservative treatment group (16/161, 9.9%). Multivariate logistic regression analysis revealed that cortical involvement (OR = 2.547; 95% CI = 1.137-5.705; p value = 0.023) and higher National Institutes of Health Stroke Scale (NIHSS) scores (OR = 1.050; 95% CI = 1.008-1.094; p value = 0.019) were independent risk factors for late seizures. Conclusion Our study revealed that receiving MIS did not increase the incidence of late seizures after ICH. Additionally, cortical involvement and NIHSS scores were independent risk factors for late seizures in MIS-treated patients.
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Affiliation(s)
- Jiahe Lin
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ru Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xianxian Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahe Ye
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchen Wang
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Beining Zhang
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Xinling Chen
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, China
| | - Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,Correspondence: Suiqiang Zhu Shanshan Huang Xinshi Wang
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Suiqiang Zhu Shanshan Huang Xinshi Wang
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Suiqiang Zhu Shanshan Huang Xinshi Wang
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Guo X, Zhong R, Han Y, Zhang H, Zhang X, Lin W. Incidence and relevant factors for seizures after spontaneous intracerebral hemorrhage: A systematic review and meta-analysis. Seizure 2022; 101:30-38. [DOI: 10.1016/j.seizure.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/01/2022] Open
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Magid-Bernstein J, Girard R, Polster S, Srinath A, Romanos S, Awad IA, Sansing LH. Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions. Circ Res 2022; 130:1204-1229. [PMID: 35420918 PMCID: PMC10032582 DOI: 10.1161/circresaha.121.319949] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Intracerebral hemorrhage (ICH) is a devastating form of stroke with high morbidity and mortality. This review article focuses on the epidemiology, cause, mechanisms of injury, current treatment strategies, and future research directions of ICH. Incidence of hemorrhagic stroke has increased worldwide over the past 40 years, with shifts in the cause over time as hypertension management has improved and anticoagulant use has increased. Preclinical and clinical trials have elucidated the underlying ICH cause and mechanisms of injury from ICH including the complex interaction between edema, inflammation, iron-induced injury, and oxidative stress. Several trials have investigated optimal medical and surgical management of ICH without clear improvement in survival and functional outcomes. Ongoing research into novel approaches for ICH management provide hope for reducing the devastating effect of this disease in the future. Areas of promise in ICH therapy include prognostic biomarkers and primary prevention based on disease pathobiology, ultra-early hemostatic therapy, minimally invasive surgery, and perihematomal protection against inflammatory brain injury.
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Affiliation(s)
| | - Romuald Girard
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Sean Polster
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Abhinav Srinath
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Sharbel Romanos
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Issam A. Awad
- Neurovascular Surgery Program, Department of Neurological Surgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Lauren H. Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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Lin R, Yu Y, Wang Y, Foster E, Kwan P, Lin M, Xia N, Xu H, Xie C, Yang Y, Wang X. Risk of Post-stroke Epilepsy Following Stroke-Associated Acute Symptomatic Seizures. Front Aging Neurosci 2021; 13:707732. [PMID: 34588971 PMCID: PMC8475904 DOI: 10.3389/fnagi.2021.707732] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: Post-stroke epilepsy (PSE) is associated with increased morbidity and mortality. Stroke-associated acute symptomatic seizures are an important risk factor: 20.8–34.3% of these patients will go on to develop PSE. Identifying these “high risk” individuals may result in earlier PSE diagnosis, treatment, and avoidance of seizure-related morbidity. This study was to identify predictors of PSE development in patients with stroke-associated acute symptomatic seizures. Participants and Methods: This was a retrospective cohort study of 167 patients with stroke-associated acute symptomatic seizures admitted to the Neurology Department of a tertiary Hospital of China, from 1 May 2006 to 30 January 2020. Both those with primary ischemic stroke and intracerebral hemorrhage were included in the study. Patient demographics, medical history, stroke-associated, and seizure-related variables were evaluated with univariable analysis and multivariable Cox regression analysis. PSE was defined as unprovoked seizures occurring > 7 days post-stroke. Data points were extracted from medical records and supplemented by tele-interview. Results: Of the 167 patients with stroke-associated acute symptomatic seizures, 49 (29.3%) developed PSE. NIHSS score > 14 [hazard ratio (HR) 2.98, 95% CI 1.57–5.67], longer interval from stroke to acute symptomatic seizures (days 4–7 post-stroke) (HR 2.51, 95% CI 1.37–4.59) and multiple acute symptomatic seizures (HR 5.08, 95% CI 2.58–9.99) were independently associated with PSE development. This association remained in the sub-analysis within the ischemic stroke cohort. In the sub-analysis of the hemorrhagic stroke cohort, multilobar involvement (HR 4.80, 95% CI 1.49–15.39) was also independently associated with development of PSE. Further, we developed a nomogram to predict individual risk of developing PSE following stroke-associated acute symptomatic seizures. The nomogram showed a C-index of 0.73. Conclusion: More severe neurofunctional deficits (NIHSS score > 14), longer interval from stroke to acute symptomatic seizures (days 4–7 post-stroke), and multiple acute symptomatic seizures were independently associated with development of PSE in patients with stroke-associated acute symptomatic seizures. This knowledge may increase clinical vigilance for development of PSE, facilitating rapid diagnosis and treatment initiation, and subsequently reduce seizure-related morbidity.
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Affiliation(s)
- Ru Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yaoyao Yu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Wang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Emma Foster
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Patrick Kwan
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mengqi Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Niange Xia
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huiqin Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenglong Xie
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Alzheimer's Disease of Zhejiang Province, Institute of Aging, Wenzhou Medical University, Wenzhou, China
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Germonpré C, Proesmans S, Bouckaert C, Sprengers M, Boon P, Raedt R, De Herdt V. Seizures and Interictal Epileptiform Activity in the Rat Collagenase Model for Intracerebral Hemorrhage. Front Neurosci 2021; 15:682036. [PMID: 34220437 PMCID: PMC8249930 DOI: 10.3389/fnins.2021.682036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Aims Intracerebral hemorrhage (ICH) is a known risk factor for the development of acute symptomatic as well as late unprovoked seizures. The underlying pathophysiology of post-ICH seizures is incompletely understood and there are no reliable predictive biomarkers. An animal model to study post-ICH seizures is currently lacking. The aim of this study was to investigate (1) the occurrence of seizures and interictal epileptiform activity in the ICH rat collagenase model using long-term video-EEG monitoring (VEM) and (2) whether seizure occurrence was associated with interictal epileptiform activity and histological features. Methods Male Sprague-Dawley rats were implanted with epidural electrodes. After 1 week of baseline VEM, collagenase was injected in left striatum to induce an ICH. VEM was continued for 180 days to assess the occurrence of post-ICH seizures and interictal epileptiform activity (spikes and epileptiform discharges). At the end of the experiment, animals were euthanized for histological characterization of the hemorrhagic lesion, using cresyl violet, Prussian blue and immunofluorescence staining. Results Acute symptomatic seizures occurred in 4/12 animals between 46 and 80 h after ICH induction. Late unprovoked seizures were present in 2/12 animals and started at 90 and 103 days post-ICH. Animals with late unprovoked seizures did not have acute symptomatic seizures. All electrographic seizures were accompanied by clear behavioral changes. Interictal spikes and epileptiform discharges were observed in all animals but occurred more frequently in rats with late seizures (p = 0.019 and p < 0.001, respectively). Animals with acute symptomatic seizures had more extended hemorrhagic lesions and hemosiderin deposits in the piriform cortex. Conclusion Both acute symptomatic and late unprovoked seizures were observed in the rat collagenase model. Interictal epileptiform activity was more frequently seen in animals with late seizures. Rats with acute symptomatic seizures showed more extensive lesions and hemosiderin deposits in the piriform cortex. This model could be used to further explore possible biomarkers for epileptogenesis.
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Affiliation(s)
| | - Silke Proesmans
- 4BRAIN, Department of Neurology, Ghent University, Ghent, Belgium
| | | | | | - Paul Boon
- 4BRAIN, Department of Neurology, Ghent University, Ghent, Belgium
| | - Robrecht Raedt
- 4BRAIN, Department of Neurology, Ghent University, Ghent, Belgium
| | - Veerle De Herdt
- 4BRAIN, Department of Neurology, Ghent University, Ghent, Belgium
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Wang Y, Li Z, Zhang X, Chen Z, Li D, Chen W, Gu J, Sun D, Rong T, Kwan P. Development and validation of a clinical score to predict late seizures after intracerebral hemorrhage in Chinese. Epilepsy Res 2021; 172:106600. [PMID: 33721707 DOI: 10.1016/j.eplepsyres.2021.106600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Seizures are a frequent complication after intracerebral hemorrhage (ICH). The CAVE score was developed in Europeans to predict late seizures after ICH. Given the higher incidence of ICH in Asians, we aimed to develop and validate a clinical scoring tool for predicting post-ICH late seizures in Chinese. METHODS We retrospectively included patients admitted with ICH to a major stroke center in Shandong province, China, in the derivation cohort, who were followed up for occurrence of late seizures (more than seven days after ICH). We applied Cox regression model to identify significant clinical factors which were used to derive a predictive scoring model. The performance of this model was compared with CAVE, and validated in a separate cohort of patients with ICH admitted to another stroke center. RESULTS In the derivation cohort (n = 602; median age 65 years; 57 % male;median follow up 24 months), 47 (7.8 %) patients had late seizures during follow up. Four significant risk factors were identified and selected to derive the LANE score (Lobar hemorrhage, Age <65 years, NIHSS score ≥15, Early seizures). The total possible points ranged from 0 to 6, corresponding to positive predictive values of 10.1%-100%, and negative predictive values of 96.8%-92.2%, respectively. The c-statistics of the LANE score in the derivation cohort and validation cohort (n = 521) were 0.83 and 0.78, respectively, while those of the CAVE score were 0.81 and 0.74, respectively. CONCLUSION We have developed and validated a clinical scoring tool for predicting late seizures after ICH in Chinese. This tool may be used to identify high risk patients for closer monitoring and clinical trials of therapies to prevent post-ICH epilepsy in the future.
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Affiliation(s)
- Yan Wang
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Zhen Li
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Xiaosai Zhang
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China; Fuzhou Children's Hospital of Fujian Province, Department of Pediatrics, Fuzhou, China.
| | - Zhibin Chen
- Monash University, Central Clinical School, Department of Neuroscience, Melbourne, Australia; Monash University, School of Public Health and Preventive Medicine, Clinical Epidemiology, Melbourne, Australia; University of Melbourne. Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia.
| | - Dongmei Li
- Qingdao Municipal Hospital, Department of Neurology, Qingdao, China.
| | - Wenxian Chen
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Jiamei Gu
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Dongyun Sun
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Ting Rong
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Patrick Kwan
- Monash University, Central Clinical School, Alfred Hospital, Department of Neuroscience, Melbourne, Australia; University of Melbourne, Royal Melbourne Hospital, Department of Neurology, Melbourne, Australia.
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Derex L, Rheims S, Peter-Derex L. Seizures and epilepsy after intracerebral hemorrhage: an update. J Neurol 2021; 268:2605-2615. [PMID: 33569652 DOI: 10.1007/s00415-021-10439-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 02/05/2023]
Abstract
Seizures are common after intracerebral hemorrhage, occurring in 6-15% of the patients, mostly in the first 72 h. Their incidence reaches 30% when subclinical or non-convulsive seizures are diagnosed by continuous electroencephalogram. Several risk factors for seizures have been described including cortical location of intracerebral hemorrhage, presence of intraventricular hemorrhage, total hemorrhage volume, and history of alcohol abuse. Seizures after intracerebral hemorrhage may theoretically be harmful as they can lead to sudden blood pressure fluctuations, increased intracranial pressure, and neuronal injury due to increased metabolic demand. Some recent studies suggest that acute symptomatic seizures (occurring within 7 days of stroke) are associated with worse functional outcome and increased risk of death despite accounting for other known prognostic factors such as age and baseline hemorrhage volume. However, the impact of seizures on prognosis is still debated and it remains unclear if treating or preventing seizures might lead to improved clinical outcome. Thus, the currently available scientific evidence does not support the routine use of antiseizure medication as primary prevention among patients with intracerebral hemorrhage. Only prospective adequately powered randomized-controlled trials will be able to answer whether seizure prophylaxis in the acute or longer term settings is beneficial or not in patients with intracerebral hemorrhage.
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Affiliation(s)
- Laurent Derex
- Stroke Center, Department of Neurology, Neurological Hospital, Hospices Civils de Lyon, University of Lyon, 59 boulevard Pinel, 69677, Bron cedex, France.
- Research On Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France.
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, University of Lyon, Lyon, France
- Lyon 1 University, Lyon, France
- INSERM U1028-CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France
| | - Laure Peter-Derex
- Lyon 1 University, Lyon, France.
- INSERM U1028-CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France.
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, University of Lyon, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.
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Sprügel MI, Kuramatsu JB, Volbers B, Saam JI, Sembill JA, Gerner ST, Balk S, Hamer HM, Lücking H, Hölter P, Nolte CH, Scheitz JF, Rocco A, Endres M, Huttner HB. Impact of Statins on Hematoma, Edema, Seizures, Vascular Events, and Functional Recovery After Intracerebral Hemorrhage. Stroke 2021; 52:975-984. [PMID: 33517701 DOI: 10.1161/strokeaha.120.029345] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The impact of statins on hematoma characteristics, perihemorrhagic edema (PHE), cardiovascular events, seizures, and functional recovery in patients with intracerebral hemorrhage (ICH) is insufficiently studied. METHODS Patients with ICH of the prospective UKER-ICH (Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage) study (URL: https://www.clinicaltrials.gov; Unique identifier: NCT03183167) were analyzed by multivariable regression modeling and propensity score matching, and PHE volumes were volumetrically assessed. Outcomes comprised hematoma characteristics, the impact of continuation, discontinuation, and initiation of statins on peak PHE extent, and the influence of statin treatment on the occurrence of seizures, cardiovascular adverse events, and functional recovery after ICH. RESULTS A total of 1275 patients with ICH with information on statin treatment were analyzed. Statin treatment on hospital admission (21.7%) was associated with higher rates of lobar versus nonlobar ICH (odds ratio, 1.57 [1.03-2.40]; P=0.038). Initiation of statins after ICH was associated with increased peak PHE (β=0.12, SE=0.06, P=0.008), whereas continuation versus discontinuation of prior statin treatment was not significantly associated with edema formation (P>0.10). There were no significant differences in the incidence of remote symptomatic seizures according to statin exposure during follow-up (statins: 11.5% versus no statins: 7.8%, subdistribution hazard ratio: 1.15 [0.80-1.66]; P=0.512). Patients on statins revealed less cardiovascular adverse events and more frequently functional recovery after 12 months (functional recovery: 57.7% versus 45.0%, odds ratio 1.67 [1.09-2.56]; P=0.019). CONCLUSIONS Among statin users, lobar ICH occurs more frequently as compared with nonstatin users. While continuation of prior statin treatment appears to be safe regarding PHE formation, the initiation of statins during the first days after ICH may increase PHE extent. However, statins should be initiated thereafter (eg, at hospital discharge) to prevent cardiovascular events and potentially improve functional recovery.
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Affiliation(s)
- Maximilian I Sprügel
- Department of Neurology (M.I.S., J.B.K., B.V., J.I.S., J.A.S., S.T.G., S.B., H.M.H., H.B.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Joji B Kuramatsu
- Department of Neurology (M.I.S., J.B.K., B.V., J.I.S., J.A.S., S.T.G., S.B., H.M.H., H.B.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Bastian Volbers
- Department of Neurology (M.I.S., J.B.K., B.V., J.I.S., J.A.S., S.T.G., S.B., H.M.H., H.B.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Justina I Saam
- Department of Neurology (M.I.S., J.B.K., B.V., J.I.S., J.A.S., S.T.G., S.B., H.M.H., H.B.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Jochen A Sembill
- Department of Neurology (M.I.S., J.B.K., B.V., J.I.S., J.A.S., S.T.G., S.B., H.M.H., H.B.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Stefan T Gerner
- Department of Neurology (M.I.S., J.B.K., B.V., J.I.S., J.A.S., S.T.G., S.B., H.M.H., H.B.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Stefanie Balk
- Department of Neurology (M.I.S., J.B.K., B.V., J.I.S., J.A.S., S.T.G., S.B., H.M.H., H.B.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Hajo M Hamer
- Department of Neurology (M.I.S., J.B.K., B.V., J.I.S., J.A.S., S.T.G., S.B., H.M.H., H.B.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Hannes Lücking
- Department of Neuroradiology (H.L., P.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Philip Hölter
- Department of Neuroradiology (H.L., P.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S., A.R., M.E.)
| | - Jan F Scheitz
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S., A.R., M.E.)
| | - Andrea Rocco
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S., A.R., M.E.)
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S., A.R., M.E.).,Center for Stroke Research Berlin (M.E.).,German Center for Neurodegenerative Diseases (DZNE) (M.E.), partner site Berlin.,German Centre for Cardiovascular Research (DZHK) (M.E.), partner site Berlin
| | - Hagen B Huttner
- Department of Neurology (M.I.S., J.B.K., B.V., J.I.S., J.A.S., S.T.G., S.B., H.M.H., H.B.H.), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
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12
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Wang P, Sun Y, Yi D, Xie Y, Luo Y. Clinical features of Chinese patients in different age groups with spontaneous intracerebral hemorrhage based on multicenter inpatient information. Neurol Res 2020; 42:657-664. [PMID: 32552613 DOI: 10.1080/01616412.2020.1782082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with spontaneous intracerebral hemorrhage (ICH) have poor functional outcomes. This study investigated the status of hospitalized patients with ICH based on multicenter inpatient information. METHODS We analyzed data from the hospital information systems (HISs) of 14 tertiary hospitals, including 6 Chinese medicine hospitals and 8 western hospitals from 7 provinces and 2 municipalities. The inclusion criteria were age ≥25 years and radiologically confirmed spontaneous ICH within two weeks of symptom onset. Age groups were as follows: 25-44, 45-59, 60-74, 75-89, 90 and over 90 years old. Data are presented as the proportion (%), median (interquartile range) or mean (standard deviation). Descriptive statistical analyses were conducted to analyze demographic features, lengths of hospital stay, hospitalization expenses, hematoma locations, mortality and major comorbid conditions or complications. RESULTS Patients were recruited from October 2003 to September 2011. A total of 9475 inpatients were recruited from 14 Class III Grade A hospitals. Baseline characteristics included a mean age of 58 (20) years old and 37.2% female (3303). The largest number of ICH patients were in the 44-59-year-old group. The ratio of males to females in the 25-44-year-old age group was 2.36:1, which was the highest of all groups; the lowest male to female ratio was 1.56:1 in the 45-59-year-old age group. The ratios of males to females in the 60-74, 75-89 and ≥90-year-old age groups were 1.60:1, 1.62:1 and 1.64:1, respectively. The proportion of males in all age groups was higher than that of females, significantly greater in the 25-44-year-old age group (P < 0.001). The lengths of hospital stay ranged from 15 to 28 days. The hospitalization expenses of the 25-44-year-old patients were 50,000-100,000 RMB, and the costs of the remaining age groups were 10,000-20,000 RMB. Basal ganglia/thalamic hemorrhage was the most common site of ICH in different age groups. Lobar and multiple locations were higher in those aged >75 years. Hypertension was the primary comorbid condition in all age groups, and it showed a rising trend with increasing age. The second most common comorbidity in the 25-44-year-old age group was vascular abnormality, while in the other age groups, comorbidities included cerebral infarction, dyslipidemia, coronary heart disease, diabetes mellitus and arrhythmia. Mortality increased with age; mortality for those under the age of 74 years fluctuated between 4.09% and 5.93%, whereas in those in the 75-89 and ≥90-year-old age groups, mortality was 13.34% and 34.09%, respectively. CONCLUSIONS As age increased, the length of hospital stay, financial burden and mortality due to ICH increased. Different age groups had different distributions of neuroimaging features, major comorbid conditions or complications.
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Affiliation(s)
- Pingping Wang
- Department of Neurology and Institute of Cerebrovascular Diseases Research, Xuanwu Hospital of Capital Medical University , Beijing, China
| | - Yong Sun
- School of Statistics, Renmin University of China , Beijing, China
| | - Danhui Yi
- School of Statistics, Renmin University of China , Beijing, China
| | - Yanming Xie
- Institute of Clinical Basic Medical Sciences, China Academy of Chinese Medical Sciences , Beijing, China
| | - Yumin Luo
- Department of Neurology and Institute of Cerebrovascular Diseases Research, Xuanwu Hospital of Capital Medical University , Beijing, China
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13
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Risk factors for seizures after intracerebral hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study. Clin Neurol Neurosurg 2020; 192:105731. [PMID: 32062309 DOI: 10.1016/j.clineuro.2020.105731] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We aimed to identify risk factors for seizures after intracerebral hemorrhage, and to validate the prognostic value of the previously reported CAVE score (0-4 points: cortical involvement, age <65, volume >10 mL, and early seizures within 7 days of hemorrhage). PATIENTS AND METHODS Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) was a prospective study of spontaneous intracerebral hemorrhage. We included patients who did not have a prior history of seizure and survived to discharge. Univariate analysis and multiple logistic regression modeling were used to identify risk factors for seizure. RESULTS From 2010-2015, 3000 cases were recruited, and 2507 patients were included in this study. Seizures after hospital discharge developed in 77 patients 3.1 %). Patients with lobar (cortical) hemorrhage (OR 3.0, 95 % CI 1.8-5.0), larger hematoma volume (OR 1.5 per cm3, 95 % CI 1.2-2.0), and surgical evacuation of hematoma (OR 2.6, 95 % CI 1.4-4.8) had a higher risk of late seizure, and older patients had a lower risk (OR 0.88 per 5-year interval increase, 95 % CI 0.81-0.95). The CAVE score was highly associated with seizure development (OR 2.5 per unit score increase, 95 % CI 2.0-3.2, p < 0.0001). The CAVS score, substituting surgical evacuation for early seizure, increased the OR per unit score to 2.8 (95 % CI 2.2-3.5). CONCLUSIONS Lobar hemorrhage, larger hematoma volume, younger age, and surgical evacuation are strongly associated with the development of seizures. We validated the CAVE score in a multi-ethnic population, and found the CAVS score to have similar predictive value while representing the current practice of AED use.
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Pinho J, Costa AS, Araújo JM, Amorim JM, Ferreira C. Intracerebral hemorrhage outcome: A comprehensive update. J Neurol Sci 2019; 398:54-66. [PMID: 30682522 DOI: 10.1016/j.jns.2019.01.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/22/2018] [Accepted: 01/11/2019] [Indexed: 12/15/2022]
Abstract
Non-traumatic intracerebral hemorrhage (ICH) is associated with a significant global burden of disease, and despite being proportionally less frequent than ischemic stroke, in 2010 it was associated with greater worldwide disability-adjusted life years lost. The focus of outcome assessment after ICH has been mortality in most studies, because of the high early case fatality which reaches 40% in some population-based studies. The most robust and consistent predictors of early mortality include age, severity of neurological impairment, hemorrhage volume and antithrombotic therapy at the time of the event. Long-term outcome assessment is multifaceted and includes not only mortality and functional outcome, but also patient self-assessment of the health-related quality of life, occurrence of cognitive impairment, psychiatric disorders, epileptic seizures, recurrent ICH and subsequent thromboembolic events. Several scores which predict mortality and functional outcome after ICH have been validated and are useful in the daily clinical practice, however they must be used in combination with the clinical judgment for individualized patients. Management of patients with ICH both in the acute and chronic phases, requires health care professionals to have a comprehensive and updated perspective on outcome, which informs decisions that are needed to be taken together with the patient and next of kin.
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Affiliation(s)
- João Pinho
- Neurology Department, Hospital de Braga, Portugal.
| | - Ana Sofia Costa
- Department of Neurology, RWTH Aachen University Hospital, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
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15
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Mehta A, Zusman BE, Choxi R, Shutter LA, Yassin A, Antony A, Thirumala PD. Seizures After Intracerebral Hemorrhage: Incidence, Risk Factors, and Impact on Mortality and Morbidity. World Neurosurg 2018; 112:e385-e392. [PMID: 29355799 DOI: 10.1016/j.wneu.2018.01.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Spontaneous intracerebral hemorrhage (ICH) is one of the most frequent causes of epilepsy in the United States. However, reported risk factors for seizure after are inconsistent, and their impact on inpatient morbidity and mortality is unclear. We aimed to study the incidence, risk factors, and impact of seizures after ICH in a nationwide patient sample. METHODS We queried the Nationwide Inpatient Sample for patients admitted to the hospital with a primary diagnosis of ICH between the years 1999 and 2011. Patients were subsequently dichotomized into groups of those with a diagnosis consistent with seizure and those without. Multivariate logistic regression was used to assess risk factors for seizure in this patient sample, and the association between seizures and mortality and morbidity. Logistic regression was then used for trend analysis of incidence of seizure diagnoses over time. RESULTS We identified 220,075 patients admitted with a primary diagnosis of ICH. Of these, 11.87% had a diagnosis consistent with seizure. Factors associated with increased risk of seizure after ICH included higher categorical van Walraven score, encephalopathy, alcohol abuse, solid tumor, and prior stroke. Seizure was independently associated with decreased odds of morbidity (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.86-0.92) and mortality (OR, 0.75; 95% CI, 0.72-0.77) in multivariate models controlling for existing comorbidities. CONCLUSIONS Seizures after were associated with decreased mortality and morbidity despite attempts to correct for existing comorbidities. Continuous monitoring of these patients for seizures may not be necessary in all circumstances, despite their frequency.
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Affiliation(s)
- Amol Mehta
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Benjamin E Zusman
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ravi Choxi
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lori A Shutter
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ahmed Yassin
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arun Antony
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Parthasarathy D Thirumala
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Mehta A, Zusman BE, Shutter LA, Choxi R, Yassin A, Antony A, Thirumala PD. The Prevalence and Impact of Status Epilepticus Secondary to Intracerebral Hemorrhage: Results from the US Nationwide Inpatient Sample. Neurocrit Care 2018; 28:353-361. [DOI: 10.1007/s12028-017-0489-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Lahti AM, Saloheimo P, Huhtakangas J, Salminen H, Juvela S, Bode MK, Hillbom M, Tetri S. Poststroke epilepsy in long-term survivors of primary intracerebral hemorrhage. Neurology 2017; 88:2169-2175. [PMID: 28476758 DOI: 10.1212/wnl.0000000000004009] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/20/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To identify the incidence and predisposing factors for development of poststroke epilepsy (PSE) after primary intracerebral hemorrhage (PICH) during a long-term follow-up. METHODS We performed a retrospective study of patients who had had their first-ever PICH between January 1993 and January 2008 in Northern Ostrobothnia, Finland, and who survived for at least 3 months. These patients were followed up for PSE. The associations between PSE occurrence and sex, age, Glasgow Coma Scale (GCS) score on admission, hematoma location and volume, early seizures, and other possible risk factors for PSE were assessed using the Cox proportional hazards regression model. RESULTS Of the 615 PICH patients who survived for longer than 3 months, 83 (13.5%) developed PSE. The risk of new-onset PSE was highest during the first year after PICH with cumulative incidence of 6.8%. In univariable analysis, the risk factors for PSE were early seizures, subcortical hematoma location, larger hematoma volume, hematoma evacuation, and a lower GCS score on admission, whereas patients with infratentorial hematoma location or hypertension were less likely to develop PSE (all variables p < 0.05). In multivariable analysis, we found subcortical location (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.35-3.81, p < 0.01) and early seizures (HR 3.63, 95% CI 1.99-6.64, p < 0.01) to be independent risk factors, but patients with hypertension had a lower risk of PSE (HR 0.54, 0.35-0.84, p < 0.01). CONCLUSIONS Subcortical hematoma location and early seizures increased the risk of PSE after PICH in long-term survivors, while hypertension seemed to reduce the risk.
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Affiliation(s)
- Anna-Maija Lahti
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland.
| | - Pertti Saloheimo
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Juha Huhtakangas
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Henrik Salminen
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Seppo Juvela
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Michaela K Bode
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Matti Hillbom
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland
| | - Sami Tetri
- From the Departments of Neurosurgery (A.-M.L., H.S., S.T.), Neurology (P.S., J.H., M.H.), and Diagnostic Radiology (M.K.B.), Oulu University Hospital; and Department of Clinical Neurosciences (S.J.), University of Helsinki, Finland.
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