Seizures after spontaneous intracerebral hemorrhage

Abstract

Objective: In patients with spontaneous intracerebral hemorrhage (ICH), the risk factors for seizure and the effect of prophylactic anticonvulsants are not well known. This study aimed to determine the risk factor for seizures and the role for prophylactic anticonvulsants after spontaneous ICH.

Methods: Between 2005 and 2010, 263 consecutive patients with spontaneous ICH were retrospectively assessed with a mean follow-up of 19.5 months using medical records, updated clinical information and, when necessary, direct patient contact. The seizures were classified as early (within 1 week of ICH) or late (more than 1 week after ICH). The outcomes were measured with the Glasgow Outcome Scale at discharge and the modified Rankin Scale (mRS) at both 2 weeks and discharge.

Results: Twenty-two patients (8.4%; 9 patients with early seizures and 13 patients with late seizures) developed seizures after spontaneous ICH. Out of 263 patients, prophylactic anticonvulsants were administered in 216 patients. The prophylactic anticonvulsants were not associated with a reduced risk of early (p=0.094) or late seizures (p=0.326). Instead, the factors associated with early seizure were cortical involvement (p<0.001) and younger age (60 years or less) (p=0.046). The risk of late seizure was increased by cortical involvement (p<0.001) and communicating hydrocephalus (p=0.004). The prophylactic anticonvulsants were associated with a worse mRS at 2 weeks (p=0.024) and at last follow-up (p=0.034).

Conclusion: Cortical involvement may be a factor for provoked seizures. Although the incidence of early seizures tended to decrease in patients prescribed prophylactic anticonvulsants, no statistical difference was found.

Keywords: Anticonvulsants; Intracerebral hemorrhage, spontaneous; Risk factors; Seizure.

Fig. 1

A representative computed tomography scan on admission showing a deep intracerebral hemorrhage without intraventricular hemorrhage. Computed tomography of a 74-year-old male patient shows a 2.5×1.5 cm-sized intracerebral hemorrhage in left basal ganglia.

Fig. 2

A representative computed tomography scan on admission showing a deep intracerebral hemorrhage with intraventricular hemorrhage. Computed tomography of a 58-year-old male patient shows a 2×0.8 cm-sized intracerebral hemorrhage in left thalamus accompanied by intraventricular hemorrhage.

Fig. 3

A representative computed tomography scan on admission showing a lobar intracerebral hemorrhage without cortical involvement. Computed tomography of a 70-year-old male patient shows a 3.5×2 cm-sized intracerebral hemorrhage in right temporal lobe.

Fig. 4

A representative computed tomography of lobar intracerebral hemorrhage with cortical involvement. Computed tomography of a 64-year-old female patient shows a 3×2.5 cm-sized lobar intracerebral hemorrhage located in right parietal lobe.