Acute symptomatic seizures in cerebral venous thrombosis.

Lindgren, Erik; Silvis, Suzanne M; Hiltunen, Sini; Heldner, Mirjam R.; Serrano, Fabiola; de Scisco, Michele; Zelano, Johan; Zuurbier, Susanna M; Sánchez van Kammen, Mayte; Mansour, Maryam; Aguiar de Sousa, Diana; Penas, Sara; Al-Asady, Saleem; Ekizoglu, Esme; Redfors, Petra; Ahmed, Awet; Yesilot, Nilufer; Ghiasian, Masoud; Barboza, Miguel A; Arnao, Valencia; ... (2020). Acute symptomatic seizures in cerebral venous thrombosis. Neurology, 95(12), e1706-e1715. American Academy of Neurology 10.1212/WNL.0000000000010577

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OBJECTIVE

To identify characteristics, predictors, and outcomes of acute symptomatic seizures (ASS) in cerebral venous thrombosis (CVT), we investigated 1,281 consecutive adult patients with CVT included from 12 hospitals within the International CVT Consortium.

METHODS

We defined ASS as any seizure between symptom onset and 7 days after diagnosis of CVT. We stratified ASS into prediagnosis and solely postdiagnosis ASS. Status epilepticus (SE) was also analyzed separately. We analyzed predictors for ASS and the association between ASS and clinical outcome (modified Rankin Scale) with multivariable logistic regression.

RESULTS

Of 1,281 eligible patients, 441 (34%) had ASS. Baseline predictors for ASS were intracerebral hemorrhage (ICH; adjusted odds ratio [aOR] 4.1, 95% confidence interval [CI] 3.0-5.5), cerebral edema/infarction without ICH (aOR 2.8, 95% CI 2.0-4.0), cortical vein thrombosis (aOR 2.1, 95% CI 1.5-2.9), superior sagittal sinus thrombosis (aOR 2.0, 95% CI 1.5-2.6), focal neurologic deficit (aOR 1.9, 95% CI 1.4-2.6), sulcal subarachnoid hemorrhage (aOR 1.6, 95% CI 1.1-2.5), and female-specific risk factors (aOR 1.5, 95% CI 1.1-2.1). Ninety-three (7%) patients had solely postdiagnosis ASS, best predicted by cortical vein thrombosis (positive/negative predictive value 22%/92%). Eighty (6%) patients had SE, independently predicted by ICH, focal neurologic deficits, and cerebral edema/infarction. Neither ASS nor SE was independently associated with outcome.

CONCLUSION

ASS occurred in one-third of patients with CVT and was associated with brain parenchymal lesions and thrombosis of the superficial system. In the absence of prediagnosis ASS, no subgroup was identified with sufficient risk of postdiagnosis ASS to justify prophylactic antiepileptic drug treatment. We found no association between ASS and outcome.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Heldner, Mirjam Rachel and Arnold, Marcel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1526-632X

Publisher:

American Academy of Neurology

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

10 Nov 2020 08:43

Last Modified:

10 Nov 2020 08:50

Publisher DOI:

10.1212/WNL.0000000000010577

PubMed ID:

32759191

BORIS DOI:

10.7892/boris.147381

URI:

https://boris.unibe.ch/id/eprint/147381

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