Risk factors for in-hospital seizures and new onset epilepsy in coil embolization of aneurysmal subarachnoid hemorrhage.

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Risk factors for in-hospital seizures and new onset epilepsy in coil embolization of aneurysmal subarachnoid hemorrhage.

World Neurosurg. 2018 Apr 21;:

Authors: Nathan SK, Brahme N, Kashkoush A, Anetakis K, Jankowitz BT, Thirumala PD

Abstract
OBJECTIVE: The study aims to determine risk factors for inpatient seizures and long-term epilepsy in patients receiving coil embolization for aneurysm associated subarachnoid hemorrhage.
METHODS: A retrospective chart review was conducted for patients admitted at University of Pittsburgh Medical Center from 2010 - 2014 for subarachnoid hemorrhage. Only patients with coil embolization were included. Variables such as subdural hematoma, cerebral infarction, post-operative vasospasm, cerebral edema, and mass effect were collected. After discharge, patients were followed up to determine if they had developed epilepsy. The Chi squared test was used to assess univariate associations. Multivariable associations were assessed with a binary logistic regression model.
RESULTS: The study included 175 patients. 16 (9.1%) of the patients had seizures while in-patient. 5 out of 73 patients met criteria for epilepsy at follow-up. None of the patients with epilepsy after discharge had electrographic seizures while hospitalized. Vasospasm (OR 6.88, 95% CI 1.81 - 26.25) and Grade 5 Hunt & Hess (OR 26.16, 95% CI 3.95 - 173.49) were significantly associated with in-hospital seizures in a multivariable analysis. Epileptiform discharges on EEG were significantly associated with mass effect findings on brain imaging (OR 3.5, CI 1.05 - 11.69).
CONCLUSION: Hunt and Hess grade of 5 and vasospasm are independent risk factors for in-hospital seizures. In addition, mass effect is an independent risk factor for epileptiform discharges on EEG. Patients with these risk factors may benefit from continuous EEG. Our results may indicate that there is no association between electrographic seizures and development of epilepsy.

PMID: 29689391 [PubMed - as supplied by publisher]

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