Delayed seizures after intracerebral haemorrhage

Abstract

Late seizures after intracerebral haemorrhage occur after the initial acute haemorrhagic insult subsides, and represent one of its most feared long-term sequelae. Both susceptibility to late seizures and their functional impact remain poorly characterized. We sought to: (i) compare patients with new-onset late seizures (i.e. delayed seizures), with those who experienced a recurrent late seizure following an immediately post-haemorrhagic seizure; and (ii) investigate the effect of late seizures on long-term functional performance after intracerebral haemorrhage. We performed prospective longitudinal follow-up of consecutive intracerebral haemorrhage survivors presenting to a single tertiary care centre. We tested for association with seizures the following neuroimaging and genetic markers of cerebral small vessel disease: APOE variants "2/"4, computer tomography-defined white matter disease, magnetic resonance imaging-defined white matter hyperintensities volume and cerebral microbleeds. Cognitive performance was measured using the Modified Telephone Interview for Cognitive Status, and functional performance using structured questionnaires obtained every 6 months. We performed time-to-event analysis using separate Cox models for risk to develop delayed and recurrent seizures, as well as for functional decline risk (mortality, incident dementia, and loss of functional independence) after intracerebral haemorrhage. A total of 872 survivors of intracerebral haemorrhage were enrolled and followed for a median of 3.9 years. Early seizure developed in 86 patients, 42 of whom went on to experience recurrent seizures. Admission Glasgow Coma Scale, increasing haematoma volume and cortical involvement were associated with recurrent seizure risk (all P 5 0.01). Recurrent seizures were not associated with long-term functional outcome (P = 0.67). Delayed seizures occurred in 37 patients, corresponding to an estimated incidence of 0.8% per year (95% confidence interval 0.5-1.2%). Factors associated with delayed seizures included cortical involvement on index haemorrhage (hazard ratio 1.63, P = 0.036), pre-haemorrhage dementia (hazard ratio 1.36, P = 0.044), history of multiple prior lobar haemorrhages (hazard ratio 2.50, P = 0.038), exclusively lobar microbleeds (hazard ratio 2.22, P = 0.008) and presence of 5 1 APOE "4 copies (hazard ratio 1.95, P = 0.020). Delayed seizures were associated with worse long-term functional outcome (hazard ratio 1.83, P = 0.005), but the association was removed by adjusting for neuroimaging and genetic markers of cerebral small vessel disease. Delayed seizures after intracerebral haemorrhage are associated with different risk factors, when compared to recurrent seizures. They are also associated with worse functional outcome, but this finding appears to be related to underlying small vessel disease. Further investigations into the connections between small vessel disease and delayed seizures are warranted.

Population-Based Assessment of the Long-Term Risk of Seizures in Survivors of Stroke

“…Age has been previously evaluated as a risk factor for the development of post-stroke seizures with conflicting results. 2, 3, 7, 8, 12, 13, 16 In this study, we found that younger age was strongly associated with an increased relative risk of development of seizures after stroke. In addition, we found that non-white race was associated with the development of post-stroke seizures in the multi-state analysis, but not in the Medicare claims analysis where all patients were ≥66 years of age.…”

Statin use associated with lower risk of epilepsy after intracranial haemorrhage: A population‐based cohort study

“…Patients with ICH were followed from the index date until PSE development, three years after the index date, death, withdrawal from the health insurance program, or the end of data available period (31 December 2013), whichever occurred first. Since PSE tends to develop within 3 years after stroke , patients were followed for a maximum period of 3 years to minimize the likelihood of including epilepsy caused by other factors such as brain tumour and head injury .…”

Failure of bumetanide to improve outcome after intracerebral hemorrhage in rat

“…Additionally, ion dyshomeostasis is present for at least two weeks after collagenase ICH, giving a large therapeutic window in which bumetanide could theoretically provide benefit [2]. In patients, there is also a large therapeutic window in which electrical imbalances can be addressed, with post-ICH seizures occurring from onset until months after the stroke [27,28]. It should be noted that seizures were not observed in the whole blood model of ICH [16], but they do occur in the collagenase model [16,29].…”