Epileptiform activity predicts epileptogenesis in cerebral hemorrhage

Abstract

This retrospective case-controlled study was performed to evaluate whether Epileptiform Activity, suspected clinical seizures, and/or 2HELPS2B/S after nontraumatic Intraparenchymal Hemorrhage or Subarachnoid Hemorrhage can predict Epilepsy. Hundred and thirty-two patients were included-29 (Epilepsy), 103 (Control Group). After matching, the average effect for all three risk factors was significant as follows: (1) Epileptiform Activity (p = 0.012, odds ratio 3.14), (2) suspected seizures (p = 0.021, odds ratio 3.78), and (3) 2HELPS2B/S score (p < 0.001, odds ratio 4.94). This study shows that Epileptiform Activity, suspected seizures, and particularly, the 2HELPS2B/S score in the acute phase are risk factors for the development of epilepsy after nontraumatic intraparenchymal and subarachnoid hemorrhage.

Keywords: EEG; cerebral hemorrhage; epilepsy; neuro-monitoring.

Figure 1

Flowchart showing the numbers of participants identified through the screening process. 513 patients were identified by billing codes, and five patients were identified through a separate process. Inclusion and exclusion criteria were applied, and 132 patients were ultimately included in the study.

Figure 2

(A) The probability of epilepsy versus 2HELPS2B/S score of 0, 1, or >1 for the whole cohort, IPH, and SAH presented with error bars of ±1 standard deviation. (B) The receiver‐operating characteristic (ROC) with the area under the curve for 2HELPS2B/S to predict the development of epilepsy within 2 years of hemorrhage. (C) A violin plot and a box plot for the three risk factors of epilepsy after nontraumatic subarachnoid hemorrhage or intraparenchymal hemorrhage. The credible intervals and distribution are generated with bootstrap resampling with 500 trials. The risk factors included the following: 2HELPS2B/S (binary with an odds ratio for 2HELPS2B/S>0). Irritable EEG is defined as electrographic evidence of cortical irritability (sporadic epileptiform discharges, lateralized periodic discharges, bilateral independent periodic discharges, lateralized rhythmic delta activity, generalized periodic discharges with a frequency >2 Hz or associated with “plus” features, the presence of brief potentially ictal rhythmic discharges, or electrographic seizures). Suspected‐Clinical‐Sz refers to an event while not on EEG that was reported as a possible or likely clinical seizure at the time of presentation prior to EEG initiation—essentially an acute symptomatic seizure. [Colour figure can be viewed at wileyonlinelibrary.com]