Epilepsy-associated long-term mortality after aneurysmal subarachnoid hemorrhage

Abstract

Objective:To elucidate the epilepsy-associated causes of death and subsequent excess long-term mortality among 12-month survivors of subarachnoid hemorrhage from saccular intracranial aneurysm (SIA-SAH).Methods:The Kuopio SIA Database (kuopioneurosurgery.fi) includes all SIA-SAH patients admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland. The study cohort consists of 779 patients, admitted from 1995 to 2007, who were alive at 12 months after SIA-SAH. Their use of reimbursable antiepileptic drugs and the causes of death (ICD-10) were fused from the Finnish national registries from 1994 to 2014.Results:The 779 12-month survivors were followed up until death (n = 197) or December 31, 2014, a median of 12.0 years after SIA-SAH. Epilepsy had been diagnosed in 121 (15%) patients after SIA-SAH, and 34/121 (28%) had died at the end of follow-up, with epilepsy as the immediate cause of death in 7/34 (21%). In the 779 patients alive at 12 months after SIA-SAH, epilepsy was an independent risk factor for mortality (hazard ratio 1.8, 95% confidence interval 1.1–3.0).Conclusions:Comorbid epilepsy in 12-month survivors of SIA-SAH is associated with increased risk of death in long-term follow-up. Survivors of SIA-SAH require long-term dedicated follow-up, including identification and effective treatment of comorbid epilepsy to prevent avoidable deaths.

Long-Term Complications and Influence on Outcome in Patients Surviving Spontaneous Subarachnoid Hemorrhage

“…Some aspects deserve consideration. First, the rate of long-term complications described in our cohort ranges similarly to previous reports [7,[24][25][26][27]. Symptomatic seizures requiring antiepileptic treatment were present in one out of ten patients which is in line with previous reports [24,25].…”

“…Symptomatic seizures requiring antiepileptic treatment were present in one out of ten patients which is in line with previous reports [24,25]. In a Finnish cohort, epilepsy was associated with a higher mortality in SAH survivors [7], whereas its influence on functional outcome and later social reintegration was not well established. We found symptomatic epilepsy to be an independent negative predictor for achieving favorable outcome, good subjective health, and return to work after 1 year.…”

“…Besides functional impairment, SAH survivors report a high rate of cognitive handicaps, mood disorders, and long-term complications [5,6]. Several studies investigated the prevalence of epilepsy as well as the need for VP shunt and reported associations with functional outcome, but the influence of these complications on social reintegration and subjective health in SAH patients remains unestablished [3,7]. Interestingly, whereas about 9 of 10 patients report acute headache at the onset of SAH, data on the development and impact of chronic headache in those patients are scarce [8].…”

Risk factors predicting a higher grade of subarachnoid haemorrhage in small ruptured intracranial aneurysm (< 5 mm)

“…With a 30-day mortality rate of 40%, the most serious damage caused by intracranial aneurysms (IAs) is subarachnoid haemorrhage (SAH) [1][2][3]. The rupture risk of IAs has been known to increase with increasing aneurysm size.…”

Lack of impact of polycystic kidney disease on the outcome of aneurysmal subarachnoid hemorrhage: a matched case-control study

“…The Kuopio Intracranial Aneurysm Patient and Family Database, with clinical data integrated from the national registries, using the personal identification codes, allows for retrospective construction of complete clinical lifelines of aSAH patients from Eastern Finland from birth to death or last follow-up. [34][35][36][37][38] This is a retrospective study, and as such is subject to se-lection bias. However, the unselected database from which the study population is derived, along with the 1:5 matched control group, compensates for this.…”