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25-09-2024 | Subarachnoid Hemorrhage | Original work

Comparison of Risk Factors for Early Seizures Between Angiogram-Negative and Aneurysmal Subarachnoid Hemorrhage

Authors: Ariyaporn Haripottawekul, Ava Stipanovich, Karen L. Furie, Michael E. Reznik, Ali Mahta

Abstract

Background

Early-onset seizures are common in aneurysmal subarachnoid hemorrhage (aSAH), with risk factors that have been explored. However, early-onset seizures in patients with angiogram-negative nonperimesencephalic SAH (an-SAH) are less understood. We sought to compare the incidence and risk factors of early-onset seizures between these groups.

Methods

We conducted a retrospective study of a cohort of consecutive patients admitted to an academic center between July 2016 and July 2023. Patients were categorized into aSAH or an-SAH based on imaging findings. Clinical data and electroencephalogram findings were retrieved and analyzed. Multivariable logistic regression analysis was used to determine risk factors for clinical or electrographic seizures, as well as other epileptic features.

Results

We included 473 patients (63% female) in the final analysis, of whom 79 had an-SAH and 394 had aSAH. Patients with an-SAH were older (mean age 61.9 years [standard deviation 15.9] vs. 56.7 [standard deviation 13.4]; p = 0.02). The rate of clinical or electrographic seizures was similar between the two groups (13% in aSAH vs. 11% in an-SAH; p = 0.62). Highly epileptic features (electrographic seizures, ictal-interictal continuum, and periodic epileptic discharges) occurred more frequently in the aSAH group compared with the an-SAH group, although this difference was not significant (15% vs. 8%; p = 0.09). Risk factors for seizures in aSAH were Hunt and Hess grade (odds ratio [OR] 1.25 per grade increase, 95% confidence interval [CI] 1.05–1.49; p = 0.011), modified Fisher score (OR 1.64 per point increase, 95% CI 1.25–2.15; p < 0.001), cerebral infarct (OR 3.64, 95% CI 2.13–6.23; p < 0.001), and intracerebral hemorrhage (OR 10, 95% CI 1.35–76.9; p = 0.017). However, none of these factors were associated with seizures in an-SAH.

Conclusions

Early-onset seizures occur at similar rates in patients with an-SAH and aSAH. However, seizure risk factors appear to differ between these groups. Larger prospective studies are needed to identify predictors of seizures in patients with an-SAH.

Bögli SY, Wang S, Romaguera N, Schütz V, Rafi O, Gilone M, Keller E, Imbach LL, Brandi G. Impact of seizures and status epilepticus on outcome in patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2022;36(3):751–9. https://doi.org/10.1007/s12028-022-01489-0.CrossRefPubMedPubMedCentral

Boswell S, Thorell W, Gogela S, Lyden E, Surdell D. Angiogram-negative subarachnoid hemorrhage: outcomes data and review of the literature. J Stroke Cerebrovasc Diseases Off J Natl Stroke Assoc. 2013;22(6):750–7. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.02.001.CrossRef

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. https://doi.org/10.1016/j.jbi.2008.08.010.CrossRefPubMed

Rinkel GJ, Wijdicks EF, Hasan D, Kienstra GE, Franke CL, Hageman LM, Vermeulen M, van Gijn J. Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography. Lancet (London, England). 1991;338(8773):964–8. https://doi.org/10.1016/0140-6736(91)91836-j.CrossRefPubMed

Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(Suppl 1):S31–4. https://doi.org/10.4103/sja.SJA_543_18.CrossRefPubMedPubMedCentral

Hoh BL, Ko NU, Amin-Hanjani S, Hsiang-Yi Chou S, Cruz-Flores S, Dangayach NS, Derdeyn CP, Du R, Hänggi D, Hetts SW, Ifejika NL, Johnson R, Keigher KM, Leslie-Mazwi TM, Lucke-Wold B, Rabinstein AA, Robicsek SA, Stapleton CJ, Suarez JI, Welch BG. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023. https://doi.org/10.1161/str.0000000000000436.CrossRefPubMed

Treggiari MM, Rabinstein AA, Busl KM, Caylor MM, Citerio G, Deem S, Diringer M, Fox E, Livesay S, Sheth KN, Suarez JI, Tjoumakaris S. Guidelines for the neurocritical care management of aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2023. https://doi.org/10.1007/s12028-023-01713-5.CrossRefPubMed

Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P. Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke. 2012;43(6):1711–37. https://doi.org/10.1161/str.0b013e3182587839.CrossRefPubMed

Diringer MN, Bleck TP, Claude-Hemphill J, Menon D, Shutter L, Vespa P, Bruder N, Connolly ES Jr, Citerio G, Gress D, Hänggi D, Hoh BL, Lanzino G, Le Roux P, Rabinstein A, Schmutzhard E, Stocchetti N, Suarez JI, Treggiari M, Tseng MY, Vergouwen MD, Wolf S, Zipfel G, Neurocritical Care Society. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus conference. Neurocrit Care. 2011;15(2):211–40. https://doi.org/10.1007/s12028-011-9605-9.CrossRefPubMed

10.

Sinha SR, Sullivan L, Sabau D, San-Juan D, Dombrowski KE, Halford JJ, Hani AJ, Drislane FW, Stecker MM. American Clinical Neurophysiology Society Guideline 1: minimum technical requirements for performing clinical electroencephalography. J Clin Neurophysiol Off Publ Am Electroencephalogr Soc. 2016;33(4):303–7. https://doi.org/10.1097/WNP.0000000000000308.CrossRef

11.

Tatum WO, Olga S, Ochoa JG, Munger Clary H, Cheek J, Drislane F, Tsuchida TN. American Clinical Neurophysiology Society Guideline 7: guidelines for EEG reporting. J Clin Neurophysiol Off Publ Am Electroencephalogr Soc. 2016;33(4):328–32. https://doi.org/10.1097/WNP.0000000000000319.CrossRef

12.

Jeon JP, Kim SE, Chai CL, Hong EP, Yang JS, Kang SH, Choi HJ, Cho YJ. Seizure incidence of angiogram-negative subarachnoid hemorrhage: an updated meta-analysis. J Chin Med Assoc. 2020;83(5):466–70. https://doi.org/10.1097/JCMA.0000000000000293.CrossRefPubMed

13.

Lin CL, Dumont AS, Lieu AS, Yen CP, Hwang SL, Kwan AL, Kassell NF, Howng SL. Characterization of perioperative seizures and epilepsy following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003;99(6):978–85. https://doi.org/10.3171/jns.2003.99.6.0978.CrossRefPubMed

14.

Wittstock M, Kurtieiev K, Grossmann A, Storch A, Walter U. Epileptic seizures and outcome in different subtypes of subarachnoid haemorrhage—results of a single-center retrospective analysis. J Clin Neurosci Off J Neurosurg Soc Aust. 2019;70:123–6. https://doi.org/10.1016/j.jocn.2019.08.055.CrossRef

15.

Choi KS, Chun HJ, Yi HJ, Ko Y, Kim YS, Kim JM. Seizures and epilepsy following aneurysmal subarachnoid hemorrhage: incidence and risk factors. J Korean Neurosurg Soc. 2009;46(2):93–8. https://doi.org/10.3340/jkns.2009.46.2.93.CrossRefPubMedPubMedCentral

16.

Raper DM, Starke RM, Komotar RJ, Allan R, Connolly ES Jr. Seizures after aneurysmal subarachnoid hemorrhage: a systematic review of outcomes. World Neurosurg. 2013;79(5–6):682–90. https://doi.org/10.1016/j.wneu.2012.08.006.CrossRefPubMed

17.

García-Ballestas E, Florez-Perdomo WA, Starke RM, Joaquim AF, Agrawal A, Keni RR, Moscote-Salazar LR. Risk of seizures after endovascular management of ruptured intracranial aneurysms: a systematic review and meta-analysis. J Epilepsy Res. 2020;10(2):55–61. https://doi.org/10.14581/jer.20009.CrossRefPubMedPubMedCentral

18.

Hoh BL, Nathoo S, Chi YY, Mocco J, Barker FG 2nd. Incidence of seizures or epilepsy after clipping or coiling of ruptured and unruptured cerebral aneurysms in the nationwide inpatient sample database: 2002–2007. Neurosurgery. 2011;69(3):644–50. https://doi.org/10.1227/NEU.0b013e31821bc46d.CrossRefPubMed

19.

Wong YS, Wu CS, Ong CT. Discontinuation of preventive antiepileptic drugs in patients with intracerebral hemorrhage. BMC Neurol. 2021;21(1):150. https://doi.org/10.1186/s12883-021-02177-w.CrossRefPubMedPubMedCentral

20.

Kondziella D, Friberg CK, Wellwood I, Reiffurth C, Fabricius M, Dreier JP. Continuous EEG monitoring in aneurysmal subarachnoid hemorrhage: a systematic review. Neurocrit Care. 2015;22(3):450–61. https://doi.org/10.1007/s12028-014-0068-7.CrossRefPubMed

21.

Park S, Connolly ES, Lavine SD, Meyers PM, Claassen J, Agarwal S. Functional outcomes and delayed cerebral ischemia following nonperimesencephalic angiogram-negative subarachnoid hemorrhage similar to aneurysmal subarachnoid hemorrhage. Neurosurgery. 2018;82(3):359–64. https://doi.org/10.1093/neuros/nyx188.CrossRefPubMed

Title: Comparison of Risk Factors for Early Seizures Between Angiogram-Negative and Aneurysmal Subarachnoid Hemorrhage
Authors: Ariyaporn Haripottawekul
Ava Stipanovich
Karen L. Furie
Michael E. Reznik
Ali Mahta
Publication date: 25-09-2024
Publisher: Springer US
Keywords: Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
Aneurysm
Unruptured Cerebral Aneurysm
Published in: Neurocritical Care
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-024-02120-0

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Comparison of Risk Factors for Early Seizures Between Angiogram-Negative and Aneurysmal Subarachnoid Hemorrhage

Abstract

Background

Methods

Results

Conclusions

Advances in Alzheimer's

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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Advances in Alzheimer's