Risk Factors and Prognosis of Epilepsy Following Brain Abscess

Abstract

Background and objectives:Epilepsy in patients with brain abscess is frequent but risk factors and prognosis remain undetermined. This study examined risk factors for epilepsy among survivors of brain abscess and associated prognosis.Methods:Nationwide, population-based healthcare registries were used to compute cumulative incidences and cause-specific adjusted hazard rate ratios (adj. HRRs) with 95% confidence intervals (CIs) for epilepsy among 30-day survivors of brain abscess from 1982 through 2016. Data was enriched with clinical details by medical record review of patients hospitalized from 2007 through 2016. Adjusted mortality rate ratios (adj. MRRs) were examined using epilepsy as a time-dependent variable.Results:The study included 1,179 30-day survivors of brain abscess among whom 323 (27%) developed new-onset epilepsy after a median of 0.76 years (interquartile range [IQR] 0.24-2.41). At admission for brain abscess, the median age was 46 years (IQR 32-59) in patients with epilepsy compared with 52 years (IQR 33-64) in those without epilepsy. The proportion of females was similar in patients with and without epilepsy (37%). Adj. HRRs for epilepsy were 2.44 (95% CI 1.89-3.15) for aspiration or excision of brain abscess, 2.37 (1.56-3.60) for alcohol abuse, 1.75 (1.27-2.40) for previous neurosurgery or head trauma, 1.62 (1.17-2.25) for stroke, and 1.55 (1.04-2.32) for age group 20-39 years. Cumulative incidences were increased in patients with alcohol abuse (52% vs 31%), aspiration or excision of brain abscess (41% vs. 20%), previous neurosurgery or head trauma (41% vs. 31%), and stroke (46% vs. 31%). Analysis using clinical details from medical record review of patients from 2007 through 2016 demonstrated adj. HRRs of 3.70 (2.24-6.13) for seizures at admission for brain abscess and 1.80 (1.04-3.11) for frontal lobe abscess. In contrast, adj. HRR was 0.42 (0.21-0.86) for occipital lobe abscess.Using the entire registry-based cohort, patients with epilepsy had an adj. MRR of 1.26 (1.01-1.57).Discussion:Important risk factors for epilepsy were seizures during admission for brain abscess, neurosurgery, alcoholism, frontal lobe abscess, and stroke. Epilepsy was associated with increased mortality. Anti-epileptic treatment may be guided by individual risk profiles and specialized follow-up is highlighted by increased mortality in survivors with epilepsy.

Occipital Nocardia Abscess Presenting With Positive Visual Phenomenon and Quadrantanopsia

“…4 Seizures are a common sequela of brain abscess, with frontal rather than occipital lesions proving more epileptogenic and with frequent delay to epilepsy diagnosis (median of 9 months after symptom onset). 5 EEG coinciding with an episode of flashing lights in the right hemifield confirmed ictal activity in the left posterior hemisphere. Seizures manifesting with positive visual phenomena most commonly originate from the occipital lobes, but may localize to other regions of the brain.…”

“…4 Seizures are a common sequela of brain abscess, with frontal rather than occipital lesions proving more epileptogenic and with frequent delay to epilepsy diagnosis (median of 9 months after symptom onset). 5…”

Update and approach to patients with brain abscess

“…The long-term cumulative incidence of epilepsy is 32% with a substantially increased risk among patients with frontal lobe abscess, seizures during admission for brain abscess, aspirated or excised brain abscess, previous neurosurgery before hospitalization for brain abscess, alcohol abuse, and previous stroke [20,57,83,84]. Epilepsy was also shown to be an independent risk factor for mortality in adjusted analysis among survivors of brain abscess [83]. Individuals with a previous brain abscess have an increased risk of cancer, disability pension, and death compared with matched population controls for several years after treatment [12 & ,20,57,85 & ].…”

“…Prognostic factors for an unfavorable outcome assessed by a Glasgow Outcome Scale score of 1–4 at 6 months after discharge include intraventricular rupture, immune-compromise, age >65 years, and female sex [3 ▪ ,4]. The long-term cumulative incidence of epilepsy is 32% with a substantially increased risk among patients with frontal lobe abscess, seizures during admission for brain abscess, aspirated or excised brain abscess, previous neurosurgery before hospitalization for brain abscess, alcohol abuse, and previous stroke [20,57,83,84]. Epilepsy was also shown to be an independent risk factor for mortality in adjusted analysis among survivors of brain abscess [83].…”

Risk Factors and Prognosis of Epilepsy Following Brain Abscess

“…In the short form version of the Research Article “Risk Factors and Prognosis of Epilepsy Following Brain Abscess: A Nationwide Population-Based Cohort Study” by Bodilsen et al, 1 some discrepancies in the text were clarified. The short form article has been replaced by an updated version.…”