Seizures After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review of Outcomes

Raper, Daniel; Starke, Robert M.; Komotar, Ricardo J.; Allan, Rodney; Connolly, E. Sander

doi:10.1016/j.wneu.2012.08.006

Cited by 50 publications

(62 citation statements)

References 54 publications

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“…Previous studies have identified several risk factors for the development of seizures during the acute hospitalization period following spontaneous SAH, including aneurysmal etiology, middle cerebral artery aneurysms, thickness of SAH clot, associated intracerebral hematoma, rebleeding, infarction, and poor neurological grade. 2,3,10 Univariate and adjusted logistic regression analyses of this sample parallel these prior findings; in our study poor neurologic grade on admission, cisternal SAH burden, and intraventricular hemorrhage were all significant predictors of seizure occurrence.…”

Section: Discussionsupporting

confidence: 86%

“…), as well as rebleeding and delayed ischemic neurologic deficits (DIND, or cerebral vasospasm). 2,3 Literature has reported seizure rates to be as high as 27% in this population. 4 These high rates of seizures, as well as concern over the possible consequences of a seizure in the setting of an unsecured aneurysm, has led to routine prophylactic administration of antiepileptic drugs (AEDs) following SAH in many centers.…”

Section: Introductionmentioning

confidence: 85%

“…4 These high rates of seizures, as well as concern over the possible consequences of a seizure in the setting of an unsecured aneurysm, has led to routine prophylactic administration of antiepileptic drugs (AEDs) following SAH in many centers. 2,3 …”

Section: Introductionmentioning

confidence: 99%

“…6 Systematic reviews examining AEDs and seizures following SAH found no recent literature supporting the effectiveness of AED prophylaxis. 3,7 Furthermore, up to 21% of those receiving AED prophylaxis suffered adverse medication side effects, including impaired liver function, thrombocytopenia, rash, and Stevens-Johnson syndrome. Few studies to date have specifically evaluated prophylactic AED treatment protocols, and only one has detailed the incidence and risk factors of clinical seizures in patients not receiving prophylactic AED medications.…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic Antiepileptics and Seizure Incidence Following Subarachnoid Hemorrhage

Panczykowski

Pease

Yin

et al. 2016

Stroke

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Background and Purpose The utility of prophylactic antiepileptic drug (AED) administration following spontaneous subarachnoid hemorrhage (SAH) remains controversial. AEDs have not clearly been associated with a reduction in seizure incidence and have been associated with both neurologic worsening and delayed functional recovery in this setting. Methods We retrospectively analyzed a prospectively collected database of SAH patients admitted to our institution between 2005 and 2010. Between 2005 and 2007, all patients received prophylactic AEDs upon admission. After 2007 no patients received prophylactic AEDs or had AEDs immediately discontinued if initiated at an outside hospital. A propensity score-matched analysis was then performed to compare the development of clinical and/or electrographic seizures in these two populations. Results 353 patients with spontaneous SAH were analyzed, 43% of whom were treated with prophylactic AEDs upon admission. Overall, 10% of patients suffered clinical and/or electrographic seizures, most frequently occurring within 24-hrs of ictus (47%). The incidence of seizures did not vary significantly based on the use of prophylactic AEDs (11 vs. 8%, p=0.33). Propensity score-matched analyses suggest that patients receiving prophylactic AEDs had a similar likelihood of suffering seizures as those who did not (p=0.49). Conclusions Propensity score-matched analysis suggests that prophylactic AEDs do not significantly reduce the risk of seizure occurrence in patients with spontaneous SAH.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prophylactic Antiepileptics and Seizure Incidence Following Subarachnoid Hemorrhage

Panczykowski

Pease

Yin

et al. 2016

Stroke

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“…Aneurysm location was associated with increased risk of these electrographic seizures in our sample. MCA aneurysms have been previously reported to be common among SAH patients who developed seizures [14], potentially due to a cortical injury related to the region of primary hemorrhage or subsequent craniotomy [15–17]. Contrary to previous publications, age [7, 18], seizure at ictus [9], high radiologic grade SAH [13, 19, 20], ICH, and hydrocephalus [16] among high-grade SAH patients did not independently increase the risk of in-hospital electrographic seizures, although such patients were encountered with low incidence in this single-center cohort.…”

Section: Discussionmentioning

confidence: 99%

High Risk for Seizures Following Subarachnoid Hemorrhage Regardless of Referral Bias

et al. 2014

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Background To investigate the frequency, predictors, and clinical impact of electrographic seizures in patients with high clinical or radiologic grade non-traumatic subarachnoid hemorrhage (SAH), independent of referral bias. Methods We compared rates of electrographic seizures and associated clinical variables and outcomes in patients with high clinical or radiologic grade non-traumatic SAH. Rates of electrographic seizure detection before and after institution of a guideline which made continuous EEG monitoring routine in this population were compared. Results Electrographic seizures occurred in 17.6 % of patients monitored expressly because of clinically suspected subclinical seizures. In unselected patients, seizures still occurred in 9.6 % of all cases, and in 8.6 % of cases in which there was no a priori suspicion of seizures. The first seizure detected occurred 5.4 (IQR 2.9–7.3) days after onset of subarachnoid hemorrhage with three of eight patients (37.5 %) having the first recorded seizure more than 48 h following EEG initiation, and 2/8 (25 %) at more than 72 h following EEG initiation. High clinical grade was associated with poor outcome at time of hospital discharge; electrographic seizures were not associated with poor outcome. Conclusions Electrographic seizures occur at a relatively high rate in patients with non-traumatic SAH even after accounting for referral bias. The prolonged time to the first detected seizure in this cohort may reflect dynamic clinical features unique to the SAH population.

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Specific treatment of aneurysmal subarachnoid hemorrhage

Arnone

Amin‐Hanjani

2019

Warlow's Stroke

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Seizures After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review of Outcomes

Cited by 50 publications

References 54 publications

Prophylactic Antiepileptics and Seizure Incidence Following Subarachnoid Hemorrhage

Prophylactic Antiepileptics and Seizure Incidence Following Subarachnoid Hemorrhage

High Risk for Seizures Following Subarachnoid Hemorrhage Regardless of Referral Bias

Specific treatment of aneurysmal subarachnoid hemorrhage

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