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Early seizures after intracerebral hemorrhage predict drug-resistant epilepsy

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Abstract

Seizures are a common complication after an intracerebral hemorrhage (ICH) and the epilepsy might even be drug resistant. It is not known which factors determine the treatment response in post-ICH epilepsy. We included ICH patients retrospectively who survived at least the first 7 days, in the period from 2004 to 2009 and assessed seizure occurrence up to May 2013. We defined early seizures (ES) as seizures occurring within the first 7 days after the ICH, and late seizures (LS) as seizures occurring later than 7 days after the ICH. We defined drug-resistant epilepsy as a non-response to two adequately chosen and dosed drug regimens. In 857 patients surviving at least 7 days after ICH 69 (8.1 %), patients developed ES whereas LS occurred in 84 (9.8 %) subjects. Patients with ES had higher odds to develop LS, as compared to patients without ES [OR 3.4; 95 % confidence interval (CI) 2.1–5.6]. Drug-resistant post-ICH epilepsy occurred in 19 patients (22.6 %). The most important independent risk factor was the occurrence of ES (OR 3.0; 95 %-CI 1.1–8.4). ES are the main independent risk factor for the development of LS and for the development of drug-resistant epilepsy. Thus, ES might hallmark the start of chronic epilepsy after intracerebral hemorrhage and are not to be considered of no significance.

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Conflicts of interest

Dr. de Greef, Dr. Schreuder, Dr. Vlooswijk, Dr. Schreuder, Dr. Rooyer, Dr. Van Oostenbrugge, and Dr. Rouhl report no competing interests or disclosures.

Ethical standard

The study was approved by the medical ethical committees of all three participating hospitals as a study without obligations to the Dutch Act of Scientific Research in Humans (‘niet-WMO’ onderzoek).

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Authors and Affiliations

  1. Department of Neurology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    Bianca T. A. de Greef, Floris H. B. M. Schreuder, Mariëlle C. G. Vlooswijk, Robert J. van Oostenbrugge & Rob P. W. Rouhl

  2. Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands

    Floris H. B. M. Schreuder & Robert J. van Oostenbrugge

  3. School for Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands

    Mariëlle C. G. Vlooswijk, Robert J. van Oostenbrugge & Rob P. W. Rouhl

  4. Department of Neurology, Atrium Medical Center, Heerlen, The Netherlands

    A. H. C. M. L. Schreuder

  5. Department of Neurology, Orbis Medical Center, Sittard, The Netherlands

    Fergus A. Rooyer

Authors
  1. Bianca T. A. de Greef
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  2. Floris H. B. M. Schreuder
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  3. Mariëlle C. G. Vlooswijk
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  4. A. H. C. M. L. Schreuder
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  5. Fergus A. Rooyer
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  6. Robert J. van Oostenbrugge
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  7. Rob P. W. Rouhl
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Corresponding author

Correspondence to Rob P. W. Rouhl.

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de Greef, B.T.A., Schreuder, F.H.B.M., Vlooswijk, M.C.G. et al. Early seizures after intracerebral hemorrhage predict drug-resistant epilepsy. J Neurol 262, 541–546 (2015). https://doi.org/10.1007/s00415-014-7592-4

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  • DOI: https://doi.org/10.1007/s00415-014-7592-4

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