Seizures After Intracerebral Hemorrhage: Incidence, Risk Factors, and Impact on Mortality and Morbidity

Mehta, Amol; Zusman, Benjamin; Choxi, Ravi; Shutter, Lori; Yassin, Ahmed; Antony, Arun

doi:10.1016/j.wneu.2018.01.052

Cited by 18 publications

(16 citation statements)

References 35 publications

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“…Seizure complicates major subsets of patients with stroke, and newer anti-epileptics are being favored in many clinical settings for seizure prophylaxis due to their good safety profile 1 . Levetiracetam has become one of the most commonly used antiepileptic in current practice for treatment as well as prophylaxis against seizures.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Levetiracetam causing acute liver failure complicating post-operative management in a neurosurgical patient

Jayashankar¹,

Munakomi²,

Sayeerajan³

et al. 2019

F1000Res

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Background: Herein we report a rare case of acute liver failure due to levetiracetam, which has been considered to have an excellent safety profile with minimal hepatic side effects. Case presentation: A 55-year-old male patient presenting with sudden onset dizziness, slurring of speech and headache was operated for posterior fossa cerebellar hematoma. His post-surgical period was complicated by development of icterus with elevation of liver enzymes. After ruling out common inciting factors, it was decided to stop levetiracetam which was given prophylactically for preventing seizures owing to presence of external ventricular drain. From the next day patient had dramatic improvement in liver functions and sensorium. Conclusions: We would like to highlight this side effect that is potentially life threatening, though rare, of levetiracetam, which is very commonly used in today’s practice and fast superseding all other time-tested antiepileptics.

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Section: Introductionmentioning

confidence: 99%

Case Report: Levetiracetam causing acute liver failure complicating post-operative management in a neurosurgical patient

Jayashankar¹,

Munakomi²,

Sayeerajan³

et al. 2019

F1000Res

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“…Hydroxysafflor yellow A, found in Honghua, provides neuroprotection against cerebral injury by modulating inflammatory and apoptotic processes 38. In addition, Dilong, Chishao, and Taoren have beneficial effects on cerebral ischemic injury 39. The above experimental evidence provides possible explanations for the beneficial neuroprotective effects of BYHWT in stroke patients.…”

Section: Discussionmentioning

confidence: 97%

“…Age, sex, low income, hypertension, hyperlipidemia, diabetes mellitus, and mental disorder were the factors associated with stroke 24. These sociodemographic factors and medical conditions are also associated with epilepsy 25. In addition, neurosurgery, intensive care, and length of hospital stay also impact the incidence of post-stroke epilepsy 26.…”

Section: Discussionmentioning

confidence: 99%

The effects of Bu Yang Huan Wu Tang on post-stroke epilepsy: a nationwide matched study

Weng

Chen

Yeh

et al. 2018

CLEP

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ObjectiveTo compare the long-term risk of epilepsy in stroke patients who use Bu Yang Huan Wu Tang (BYHWT) and those who do not.MethodsIn the Taiwanese national insurance claims data, we identified newly diagnosed stroke patients receiving inpatient care in the years 2000–2004. Using propensity score-matched pairs to balance the baseline characteristics, we selected eligible stroke patients who did (n=8,971) and did not (n=8,971) receive BYHWT. These two groups were followed up until the end of 2009 to track the occurrence of epilepsy. We used Cox proportional hazard models to calculate the adjusted HRs and 95% CIs for post-stroke epilepsy during the follow-up period according to BYHWT use.ResultsCompared with the control group, stroke patients with BYHWT had a reduced risk of epilepsy during the 5–9 years of the follow-up period (HR 0.69, 95% CI 0.61–0.77). The association between BYHWT and reduced post-stroke epilepsy was significant in various subgroups of stroke patients. There was a dose-dependent decrease in the frequency of epilepsy with increasing quantities of BYHWT use from 1 package (HR 0.77, 95% CI 0.66–0.90) to ≥6 packages (HR 0.52, 95% CI 0.42–0.65).ConclusionStroke patients who received BYHWT therapy had a reduced long-term risk of epilepsy, and the beneficial effect could be observed in various subgroups. However, future clinical trials will be necessary to corroborate the present findings and identify the biochemical mechanism involved.

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“…5 Paradoxically, several studies found that seizures independently decreased morbidity and mortality in patients with ICH. 17,18 Mehta et al and Bruning et al both found patients with ESs tended to have less severe neurological deterioration and less altered consciousness level at presentation, hence the lower mortality rates. 17,18 EEG was not routinely performed in both studies and it is possible that patients who had severe ICH had subclinical or non-motor seizures but were not diagnosed to have seizures.…”

Section: Introductionmentioning

confidence: 98%

“…17,18 Mehta et al and Bruning et al both found patients with ESs tended to have less severe neurological deterioration and less altered consciousness level at presentation, hence the lower mortality rates. 17,18 EEG was not routinely performed in both studies and it is possible that patients who had severe ICH had subclinical or non-motor seizures but were not diagnosed to have seizures. 17,18 Given the uncertainties with regards to post-ICH seizures highlighted above, we aimed to explore the risk factors for ESs after ICH and whether administration of tranexamic acid increased the risk of seizure.…”

Section: Introductionmentioning

confidence: 98%

Incidence and predictors of early seizures in intracerebral haemorrhage and the effect of tranexamic acid

Law

England

Mistri

et al. 2020

European Stroke Journal

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Introduction Seizures are common after intracerebral haemorrhage. Tranexamic acid increases the risk of seizures in non-intracerebral haemorrhage population but its effect on post-intracerebral haemorrhage seizures is unknown. We explored the risk factors and outcomes of seizures after intracerebral haemorrhage and if tranexamic acid increased the risk of seizures in the Tranexamic acid for IntraCerebral Haemorrhage-2 trial. Patients and methods Seizures were reported prospectively up to day 90. Cox regression analyses were used to determine the predictors of seizures within 90 days and early seizures (≤7 days). We explored the effect of early seizures on day 90 outcomes. Results Of 2325 patients recruited, 193 (8.3%) had seizures including 163 (84.5%) early seizures and 30 (15.5%) late seizures (>7 days). Younger age (adjusted hazard ratio (aHR) 0.98 per year increase, 95% confidence interval (CI) 0.97–0.99; p = 0.008), lobar haematoma (aHR 5.84, 95%CI 3.58–9.52; p < 0.001), higher National Institute of Health Stroke Scale (aHR 1.03, 95%CI 1.01–1.06; p = 0.014) and previous stroke (aHR 1.66, 95%CI 1.11–2.47; p = 0.013) were associated with early seizures. Tranexamic acid did not increase the risk of seizure within 90 days. Early seizures were associated with worse modified Rankin Scale (adjusted odds ratio (aOR) 1.79, 95%CI 1.12–2.86, p = 0.015) and increased risk of death (aOR 3.26, 95%CI 1.98–5.39; p < 0.001) at day 90. Discussion and conclusion: Lobar haematoma was the strongest independent predictor of early seizures after intracerebral haemorrhage. Tranexamic acid did not increase the risk of post-intracerebral haemorrhage seizures in the first 90 days. Early seizures resulted in worse functional outcome and increased risk of death.

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Seizures After Intracerebral Hemorrhage: Incidence, Risk Factors, and Impact on Mortality and Morbidity

Cited by 18 publications

References 35 publications

Case Report: Levetiracetam causing acute liver failure complicating post-operative management in a neurosurgical patient

Case Report: Levetiracetam causing acute liver failure complicating post-operative management in a neurosurgical patient

The effects of Bu Yang Huan Wu Tang on post-stroke epilepsy: a nationwide matched study

Incidence and predictors of early seizures in intracerebral haemorrhage and the effect of tranexamic acid

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