Association of Seizure Occurrence with Aneurysm Treatment Modality in Aneurysmal Subarachnoid Hemorrhage Patients
Data on new-onset seizures after treatment of aneurysmal subarachnoid hemorrhage (aSAH) patients are limited and variable. We examined the association between new-onset seizures after aSAH and aneurysm treatment modality, as well their relationship with initial clinical severity of aSAH and outcomes.
This is a retrospective cohort study of all aSAH patients admitted to our institution over a 6-year period. ‘Seizures’ were defined as any observed clinical seizure or electrographic seizure on continuous electroencephalogram (cEEG) recordings, as determined by the reviewing neurophysiologist. Subgroup analyses were performed in low-grade (Hunt–Hess 1–3) and high-grade (Hunt–Hess 4–5) patients. Outcomes measures were Glasgow Coma Score (GCS) at intensive care unit (ICU) discharge and modified Rankin Scale (mRS) at outpatient follow-up.
There were 282 patients with aSAH; 203 (72.0%) suffered low-grade and 79 (28%) high-grade aSAH. Patients were treated with endovascular coiling (N = 194, 68.8%) or surgical clipping (N = 66, 23.4%). Eighteen (6.4%) patients had seizures, of whom 10 (5.5%) had aneurysm coiling and 7 (10.6%) underwent clipping (p = 0.15). In low-grade patients, seizures occurred less frequently (p = 0.016) and were more common after surgical clipping (p = 0.0089). Seizures correlated with lower GCS upon ICU discharge (p < 0.001), in clipped (p = 0.011) and coiled (p < 0.001) patients and in low-grade aSAH (p < 0.001). Seizures correlated with higher mRS on follow-up (p < 0.001), in clipped (p = 0.032) and coiled (p = 0.004) patients and in low-grade aSAH (p = 0.003).
New-onset seizures after aSAH occurred infrequently, and their incidence after aneurysm clipping versus coiling was not significantly different. However, in low-grade patients, new seizures were more frequently associated with clipping than coiling. Additionally, non-convulsive seizures did not occur in low-grade patients treated with coiling. These findings may explain, in part, previous work suggesting better outcomes in coiled patients and encourage physicians to have a lower threshold for cEEG utilization in low-grade patients suspected to have acute seizures after surgical clipping.
KeywordsSeizures Aneurysmal subarachnoid hemorrhage Clipping Coiling
Dr. Linda Gerber and Ms. Xian Wu were supported in part by funds from the Clinical and Translational Science Center (CTSC) and National Center for Advancing Translational Sciences (NCAS) Grant #2UL1-TR000457-06. Dr. Peter B. Forgacs was supported in part by funds from the NIH NINDS K23 NS096222; Leon Levy Neuroscience Fellowship Award; NIH UL1 TR000043 NCATS Rockefeller CTSA Program and The Stavros Niarchos Foundation. Dr. Santosh B. Murthy was supported in part by research fellowships from the American Academy of Neurology, American Brain Foundation, and the Leon Levy Foundation.
Author contributions to the study and manuscript preparation include the following. Mangat, Allen, and Forgacs contributed to conception and design and drafted the article. Allen and Fakhar helped in acquisition of data. Mangat, Gerber, Wu, and Allen participated in analysis and interpretation of data. All authors critically revised the article and reviewed the submitted version of manuscript. Mangat supervised the study. Mangat approved the final version of the manuscript on behalf of all authors. Mangat and Stieg provided administrative/technical/material support.
Compliance with Ethical Standards
Conflict of interest
The authors report no conflict of interest concerning the materials or methods used in this study or the findings of this paper.
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