Predictors of seizure onset after intracerebral hemorrhage and the role of long-term antiepileptic therapy

Abstract

Objective: Seizures are a common complication after hemorrhagic stroke that may slow recovery and decrease quality of life. Recent evidence suggests that early- and late-onset seizures have distinct etiologies, rendering the role of prophylactic long-term antiepileptic drugs controversial. We investigated predictors of early- and late-onset seizures after evacuation of intracerebral hemorrhage (ICH) in an attempt to guide antiepileptic drug management in this patient population.

Methods: We performed a retrospective analysis of 110 patients admitted to Columbia University Medical Center between 1999 and 2007 for ICH and subsequent clot evacuation. Patients were included if they had a head computed tomography indicating ICH, an operative note confirming surgical evacuation, and sufficient medical records to determine seizure status. Demographic, clinical, and radiographic findings were recorded. Univariate and multivariate logistic regression analyses were used to determine factors associated with early- and late-onset electrographic and clinical seizures.

Results: Seizures occurred in 41.8% of patients, 29.6% of which had clinical manifestations and 16.3% of which were recorded on continuous electroencephalogram (EEG). After controlling for demographic factors, multivariate analysis identified 3 factors that were predictive of early-onset seizures (volume of hemorrhage, presence of subarachnoid hemorrhage, and subdural hemorrhage) and 2 factors that were predictive of late onset seizures (subdural hemorrhage and increased admission international normalized ratio (INR)).

Conclusions: The presence of subdural hematoma and increased INR is predictive of late-onset seizures in patients undergoing clot evacuation after ICH. The use of long-term antiepileptic therapy should be further studied in patients with these radiographic and clinical characteristics.