gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Epilepsy after aneurysmal subarachnoid haemorrhage – incidence, timing and risk factors

Epilepsie nach aneurysmatischer Subarachnoidalblutung – Inzidenz, Zeitpunkt und Risikofaktoren

Meeting Abstract

  • Leonie Droste - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Annika Herten - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Thiemo Florin Dinger - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Daniela Pierscianek - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Karsten Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV150

doi: 10.3205/21dgnc145, urn:nbn:de:0183-21dgnc1458

Published: June 4, 2021

© 2021 Droste et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Aneurysmal subarachnoid hemorrhage (SAH) is a severe type of stroke accompanied with a number of early and late complications resulting in considerable morbidity and mortality. Several studies have already pointed to a delayed risk of post-SAH epilepsy, which is associated with poor outcome. We sought to analyze the risk factors related to the occurrence and timing symptomatic epilepsy after SAH.

Methods: All consecutive SAH cases treated between 01/2003 and 06/2016 were included from our institutional SAH register. Occurrence of epilepsy during the whole documented post-SAH period was followed up to 03/2020. Demographic characteristics and previous medical history of the patients, parameters of initial severity, performed treatments, certain early and late complications of SAH, as well as daily routine laboratory and vital parameter measurements were collected for further assessment with the epilepsy risk in univariate and multivariate analysis.

Results: During the 2811.65 patient-years of post-SAH follow-up (median: 8.93 months/patient), 85 of 948 individuals (9%) in the final analysis developed a symptomatic epilepsy (median: 3.43 months after ictus). In the majority of the cases, epilepsy was diagnosed >3 weeks after SAH (n=61, 71.8%) and in survivors with poor outcome at discharge (mRS=4-5, 15.8% vs. 5.3%, p<0.0001). Patients with epilepsy were at higher risk for functional disability at 6 months after SAH (mRS>2, 61.2% vs. 44.8%, p=0.004). Of over 100 analyzed potential predictors, the following parameters were independently associated with the risk of symptomatic epilepsy after SAH: history of thyroid dysfunction (aHR=1.81, p=0.029), need for decompressive craniectomy (aOR=2.32, p=0.011) and shunt placement (aHR=1.94, p=0.022), persistence of tachycardia (>3 days, aOR=2.06, p=0.025), as well as anemia signs (mean erythrocytes count < 3.6x106 /mcL [aOR=2.4, p=0.015] and mean hematocrit <31% [aOR=2.13, p=0.044]) during first 2 weeks after SAH.

Conclusion: Symptomatic epilepsy occurs predominantly in individuals with poor outcome at discharge and after the acute phase of SAH. The knowledge on the risk factors for SAH-related epilepsy might help in early identification and treatment of compromised individuals, and therefore, help to improve their outcome.