[Epilepsy in patients suffering from severe subarachnoid haemorrhage]

Seizures and anticonvulsants after aneurysmal subarachnoid hemorrhage

Seizures and seizure-like activity may occur in patients experiencing aneurysmal subarachnoid hemorrhage. Treatment of these events with prophylactic antiepileptic drugs remains controversial. An electronic literature search was conducted for English language articles describing the incidence and treatment of seizures after aneurysmal subarachnoid hemorrhage from 1980 to October 2010. A total of 56 articles were included in this review. Seizures often occur at the time of initial presentation or aneurysmal rebleeding before aneurysm treatment. Seizures occur in about 2% of patients after invasive aneurysm treatment, with a higher incidence after surgical clipping compared with endovascular repair. Non-convulsive seizures should be considered in patients with poor neurological status or deterioration. Seizure prophylaxis with antiepileptic drugs is controversial, with limited data available for developing recommendations. While antiepileptic drug use has been linked to worse prognosis, studies have evaluated treatment with almost exclusively phenytoin. When prophylaxis is used, 3-day treatment seems to provide similar seizure prevention with better outcome compared with longer-term treatment.

Traitement de l'hémorragie méningée anévrismale

The incidence of subarachnoid hemorrhages is about 10.5/100,000 persons/year. Early obliteration of the aneurysmal sac is necessary to avoid rebleeding. The neurovascular staff meeting must decide the appropriate obliteration procedure for each patient. Intraoperative morbidity is 8% after endovascular coiling and 10% after microsurgical clipping. Endovascular coiling leads to complete obliteration of the aneurysm in 60% of patients and microsurgical clipping in 95%. Delayed ischemic deficits may be prevented by volemic expansion and calcium channel blockers. Hospitalization and general prophylaxis against deep venous thrombosis, pain and seizures are essential. Curative treatment is required against common complications such as intraparenchymatous hematoma, hydrocephalus, and delayed ischemic deficit.