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. 2019 Sep;140(3):194-203.
doi: 10.1111/ane.13131. Epub 2019 Jun 11.

Seizure and status epilepticus in chronic subdural hematoma

Sae-Yeon Won  1 , Daniel Dubinski  1 , Lisa Sautter  1 , Elke Hattingen  2 , Volker Seifert  1 , Felix Rosenow  3 , Thomas Freiman  1 , Adam Strzelczyk  3 , Juergen Konczalla  1
Affiliations

Seizure and status epilepticus in chronic subdural hematoma

Sae-Yeon Won et al. Acta Neurol Scand. 2019 Sep.

Abstract

Background: Acute symptomatic seizure (ASz) and status epilepticus (SE) are serious conditions associated with poor quality of life, with unfavorable psychosocial and functional outcome. Chronic subdural hematoma (cSDH) is a common neurosurgical disease related to those complications; therefore, we aimed to evaluate incidence, predictors of ASz/SE, and outcome in this cohort.

Methods: We retrospectively analyzed patient diagnosed cSDH between 2010 and 2017. Beside their incidence of ASz/SE, patient characteristics, symptoms at admission, comorbidities, and all previously published relevant parameters were assessed. Recurrence rate and functional outcome were analyzed at hospital discharge and 90-day follow-up.

Results: A total of 375 patients were included; incidence of ASz was 15.2% and of SE, 1.9%. In the univariate analysis, drainage insertion (P = 0.004; OR = 0.3) was a significant negative predictor for ASz/SE and multivariate analysis, including all significant parameters, designated GCS ≤13 at admission (P = 0.09; OR = 1.9), remote stroke (P = 0.009; OR = 2.9), and recurrence rate within 14 days (P = 0.001; OR = 3.3; with an incidence of 13%) as independent predictors for ASz/SE. Overall, patients with ASz/SE had significantly unfavorable outcome at discharge (54.7%; P < 0.001) and follow-up (39.5%; P < 0.001) with only slight improvement. Late seizures occurred in 3.8% within follow-up period. Any patient with SE had an unfavorable outcome at discharge without any improvement at follow-up having a mortality rate of 14.2%.

Conclusion: Independent predictors for ASz/SE are GCS ≤13 at admission, remote stroke, and recurrent hematoma in patients with cSDH, which is associated with worse functional outcome, particularly those with SE. Due to the higher rate of seizures than recurrence rate, a routine pre- and postoperative EEG besides CT is recommended.

Keywords: EEG; chronic subdural hematoma; functional outcome; predictors; seizures; status epilepticus.

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