Advertisement

Neurocritical Care

, Volume 21, Issue 3, pp 476–482 | Cite as

High Risk for Seizures Following Subarachnoid Hemorrhage Regardless of Referral Bias

  • Kathryn L. O’Connor
  • M. Brandon Westover
  • Michael T. Phillips
  • Nicolae A. Iftimia
  • Deidre A. Buckley
  • Christopher S. Ogilvy
  • Mouhsin M. Shafi
  • Eric S. Rosenthal
Original Article

Abstract

Background

To investigate the frequency, predictors, and clinical impact of electrographic seizures in patients with high clinical or radiologic grade non-traumatic subarachnoid hemorrhage (SAH), independent of referral bias.

Methods

We compared rates of electrographic seizures and associated clinical variables and outcomes in patients with high clinical or radiologic grade non-traumatic SAH. Rates of electrographic seizure detection before and after institution of a guideline which made continuous EEG monitoring routine in this population were compared.

Results

Electrographic seizures occurred in 17.6 % of patients monitored expressly because of clinically suspected subclinical seizures. In unselected patients, seizures still occurred in 9.6 % of all cases, and in 8.6 % of cases in which there was no a priori suspicion of seizures. The first seizure detected occurred 5.4 (IQR 2.9–7.3) days after onset of subarachnoid hemorrhage with three of eight patients (37.5 %) having the first recorded seizure more than 48 h following EEG initiation, and 2/8 (25 %) at more than 72 h following EEG initiation. High clinical grade was associated with poor outcome at time of hospital discharge; electrographic seizures were not associated with poor outcome.

Conclusions

Electrographic seizures occur at a relatively high rate in patients with non-traumatic SAH even after accounting for referral bias. The prolonged time to the first detected seizure in this cohort may reflect dynamic clinical features unique to the SAH population.

Keywords

Subarachnoid hemorrhage Non-convulsive seizures Continuous electroencephalography 

Notes

Conflict of interest

Kathryn L. O’Connor, M. Brandon Westover, Michael T. Phillips, Nicolae A. Iftimia, Deidre A. Buckley, Christopher S. Ogilvy, Mouhsin M. Shafi, and Eric S. Rosenthal declare that they have no conflict of interest.

References

  1. 1.
    Nieuwkamp DJ, Setz LE, Algra A, Linn FHH, de Rooij NK, Rinkel GJE. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol. 2009;8:635–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012;43:1711–37.PubMedCrossRefGoogle Scholar
  3. 3.
    Claassen J, Perotte A, Albers D, Kleinberg S, Schmidt J, Tu B, et al. Nonconvulsive seizures after subarachnoid hemorrhage: multimodal detection and outcomes. Ann Neurol. 2013;74:53–64.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Sluzewski M, van Rooij WJ. Early rebleeding after coiling of ruptured cerebral aneurysms: incidence, morbidity, and risk factors. AJNR Am J Neuroradiol. 2005;26:1739–43.PubMedGoogle Scholar
  5. 5.
    Hoh BLBL, Topcuoglu MAMA, Singhal ABAB, Pryor JCJC, Rabinov JDJD, Rordorf GAGA, et al. Effect of clipping, craniotomy, or intravascular coiling on cerebral vasospasm and patient outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2004;55:779.PubMedCrossRefGoogle Scholar
  6. 6.
    Vergouwen MDI, Ilodigwe D, Macdonald RL. Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects. Stroke. 2011;42:924–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Choi K-S, Chun H-J, Yi H-J, Ko Y, Kim Y-S, Kim J-M. Seizures and epilepsy following aneurysmal subarachnoid hemorrhage: incidence and risk factors. J Korean Neurosurg Soc. 2009;46:93–8.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Lanzino G, D’Urso PI, Suarez J. Seizures and anticonvulsants after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2011;15:247–56.PubMedCrossRefGoogle Scholar
  9. 9.
    De Marchis GM, Pugin D, Lantigua H, Zammit C, Tadi P, Schmidt JM, et al. Tonic-clonic activity at subarachnoid hemorrhage onset: impact on complications and outcome. PLoS ONE. 2013;8:e71405.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Hart R, Byer J, Slaughter J, Hewett J, Easton D. Occurrence and implications of seizures in subarachnoid hemorrhage due to ruptured intracranial aneurysms. Neurosurgery. 1981;8:417–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Riordan KC, Wingerchuk DM, Wellik KE, Zimmerman RS, Sirven JI, Noe KH, et al. Anticonvulsant drug therapy after aneurysmal subarachnoid hemorrhage: a critically appraised topic. Neurologist. 2010;16:397–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol. 2005;22:79–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Lin C-L, Dumont AS, Lieu A-S, Yen C-P, Hwang S-L, Kwan A-L, et al. Characterization of perioperative seizures and epilepsy following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003;99:978–85.PubMedCrossRefGoogle Scholar
  14. 14.
    Raper DMS, Starke RM, Komotar RJ, Allan R, Connolly ES. Seizures after aneurysmal subarachnoid hemorrhage: a systematic review of outcomes. World Neurosurg. 2012;79:682–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Hart Y, Sneade M, Birks J, Rischmiller J, Kerr R, Molyneux A. Epilepsy after subarachnoid hemorrhage: the frequency of seizures after clip occlusion or coil embolization of a ruptured cerebral aneurysm: results from the International Subarachnoid Aneurysm Trial. J Neurosurg. 2011;115:1159–68.PubMedCrossRefGoogle Scholar
  16. 16.
    Keränen T, Tapaninaho A, Hernesniemi J, Vapalahti M. Late epilepsy after aneurysm operations. Neurosurgery. 1985;17:897–900.Google Scholar
  17. 17.
    Ukkola V, Heikkinen E. Epilepsy after operative treatment of ruptured cerebral aneurysms. Acta Neurochir (Wien). 1990;106:115–8.CrossRefGoogle Scholar
  18. 18.
    Dennis LJ, Claassen J, Hirsch LJ, Emerson RG. Nonconvulsive status epilepticus after subarachnoid hemorrhage. Neurosurgery. 2002;51:1136–44.PubMedCrossRefGoogle Scholar
  19. 19.
    Rhoney DH, Tipps LB, Murry KR, Basham MC, Michael DB, Coplin WM. Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage. Neurology. 2000;55:258–65.PubMedCrossRefGoogle Scholar
  20. 20.
    Hasan D, Schonck R, Avezaat C, Tanghe H, van Gijn J, van der Lugt P. Epileptic seizures after subarachnoid hemorrhage. Ann Neurol. 1993;33:286–91.PubMedCrossRefGoogle Scholar
  21. 21.
    Claassen J, Mayer S, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62:1743–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Dreier JP, Major S, Pannek H-W, Woitzik J, Scheel M, Wiesenthal D, et al. Spreading convulsions, spreading depolarization and epileptogenesis in human cerebral cortex. Brain. 2012;135:259–75.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Claassen J, Hirsch LJ, Kreiter KT, Du EY, Connolly ES, Emerson R, et al. Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage. Clin Neurophysiol. 2004;115:2699–710.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kathryn L. O’Connor
    • 1
  • M. Brandon Westover
    • 1
  • Michael T. Phillips
    • 3
  • Nicolae A. Iftimia
    • 1
  • Deidre A. Buckley
    • 4
  • Christopher S. Ogilvy
    • 4
  • Mouhsin M. Shafi
    • 1
    • 2
  • Eric S. Rosenthal
    • 1
  1. 1.Department of NeurologyMassachusetts General HospitalBostonUSA
  2. 2.Department of NeurologyBeth Israel Deaconess Medical CenterBostonUSA
  3. 3.Department of NeurosurgeryMassachusetts General HospitalBostonUSA
  4. 4.Department of NeurosurgeryBeth Israel Deaconess Medical CenterBostonUSA

Personalised recommendations