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Observational Study
. 2024 Sep;9(3):630-638.
doi: 10.1177/23969873241247745. Epub 2024 Apr 16.

Early seizures and risk of epilepsy and death after intracerebral haemorrhage: The MUCH Italy

Alessandro Pezzini  1   2 , Barbara Tarantino  3 , Marialuisa Zedde  4 , Simona Marcheselli  5 , Giorgio Silvestrelli  6 , Alfonso Ciccone  6 , Maria Luisa DeLodovici  7 , Lucia Princiotta Cariddi  7 , Simone Vidale  7 , Maurizio Paciaroni  8 , Cristiano Azzini  9 , Marina Padroni  9 , Massimo Gamba  10 , Mauro Magoni  10 , Massimo Del Sette  11 , Rossana Tassi  12 , Ivo Giuseppe De Franco  12 , Anna Cavallini  13 , Rocco Salvatore Calabrò  14 , Manuel Cappellari  15 , Elisa Giorli  16 , Giacomo Giacalone  17 , Corrado Lodigiani  18 , Mara Zenorini  15 , Francesco Valletta  15 , Gianni Cutillo  17 , Guido Bonelli  17 , Giorgia Abrignani  2 , Paola Castellini  2 , Antonio Genovese  2 , Lilia Latte  2 , Maria Claudia Trapasso  2 , Chiara Ferraro  1 , Francesco Piancatelli  8 , Rosario Pascarella  19 , Ilaria Grisendi  4 , Federica Assenza  4 , Manuela Napoli  19 , Claudio Moratti  19 , Maurizio Acampa  12 , Mario Grassi  3
Affiliations
Observational Study

Early seizures and risk of epilepsy and death after intracerebral haemorrhage: The MUCH Italy

Alessandro Pezzini et al. Eur Stroke J. 2024 Sep.

Abstract

Introduction: It is unclear which patients with non-traumatic (spontaneous) intracerebral haemorrhage (ICH) are at risk of developing acute symptomatic seizures (provoked seizures occurring within the first week after stroke onset; early seizures, ES) and whether ES predispose to the occurrence of remote symptomatic seizures (unprovoked seizures occurring more than 1 week after stroke; post-stroke epilepsy, PSE) and long-term mortality.

Patients and methods: In the setting of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy) we examined the risk of ES and whether they predict the occurrence of PSE and all-cause mortality in a cohort of patients with first-ever spontaneous ICH and no previous history of epilepsy, consecutively hospitalized in 12 Italian neurological centers from 2002 to 2014.

Results: Among 2570 patients (mean age, 73.4 ± 12.5 years; males, 55.4%) 228 (8.9%) had acute ES (183 (7.1%) short seizures and 45 (1.8%) status epilepticus (SE)). Lobar location of the hematoma (OR, 1.49; 95% CI, 1.06-2.08) was independently associated with the occurrence of ES. Of the 2,037 patients who were followed-up (median follow-up time, 68.0 months (25th-75th percentile, 77.0)), 155 (7.6%) developed PSE. ES (aHR, 2.34; 95% CI, 1.42-3.85), especially when presenting as short seizures (aHR, 2.35; 95% CI, 1.38-4.00) were associated to PSE occurrence. Unlike short seizures, SE was an independent predictor of all-cause mortality (aHR, 1.50; 95% CI, 1.005-2.26).

Discussion and conclusion: The long-term risk of PSE and death after an ICH vary according to ES subtype. This might have implications for the design of future clinical trials targeting post-ICH epileptic seizures.

Keywords: Cerebral haemorrhage; epilepsy; risk factors in epidemiology.

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Conflict of interest statement

Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Ciccone reports grants from Daiichi-Sankyo; grants from Italfarmaco; and grants from Alexion Pharmaceuticals.Dr Paciaroni reports compensation from SANOFI-AVENTIS U.S. LLC for other services; compensation from PFIZER CANADA INC for other services; compensation from iRhythm Technologies for other services; compensation from Daiichi Sankyo Europe GmbH for other services; and compensation from Bristol-Myers Squibb for other services.The other Authors have nothing to disclose.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Participants’ enrolment and eligibility criteria flow chart. Flow-chart summarizing sequential application of eligibility/exclusion criteria leading to definition of final study population. Solid bordered boxes report number of patients fulfilling eligibility criteria at each stage.
Figure 2.
Figure 2.
Post-ICH seizure diagnosis incidence over time. The incidence of newly-diagnosed seizure disorders at different time points following intracerebral haemorrhage (ICH). The dashed vertical line identifies the cut-off for definition of early versus late seizure (i.e. within or beyond 7 days from onset of ICH symptoms). PSE: post-stroke epilepsy.
See this image and copyright information in PMC

References

    1. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20: 795–820. - PMC - PubMed
    1. Qureshi AI, Tuhrim S, Broderick JP, et al.. Spontaneous intracerebral haemorrhage. N Engl J Med 2001; 344: 1450–1460. - PubMed
    1. Guo X, Zhong R, Han Y, et al.. Incidence and relevant factors for seizures after spontaneous intracerebral haemorrhage: a systematic review and meta-analysis. Seizure 2022; 101: 30–38. - PubMed
    1. Hamer HM. Seizures and epilepsies after stroke. Nervenarzt 2009; 80: 405–414. - PubMed
    1. Gilmore E, Choi HA, Hirsch LJ, et al.. Seizures and CNS haemorrhage: spontaneous intracerebral and aneurysmal subarachnoid haemorrhage. Neurologist 2010; 16: 165–175. - PubMed

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