Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage

Fung, Christian; Balmer, Mathias; Murek, Michael; Z'Graggen, Werner Josef; Abu-Isa, Janine; Ozdoba, Christoph; Hänggi, Matthias; Jakob, Stephan; Raabe, Andreas; Beck, Jürgen (2015). Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage. Journal of neurosurgery, 122(2), pp. 408-413. American Association of Neurological Surgeons 10.3171/2014.10.JNS14163

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OBJECT After subarachnoid hemorrhage (SAH), seizure occurs in up to 26% of patients. The impact of seizure on outcome has been studied, yet its impact on grading is unknown. The authors evaluated the impact of early-onset seizures (EOS) on grading of spontaneous SAH and on outcome. METHODS This retrospective analysis included consecutive patients with SAH who were treated at the NeuroCenter, Inselspital, University Hospital Bern, Switzerland, between January 2005 and December 2010. Demographic data, clinical data, and reports of EOS were recorded. The EOS were defined as seizures occurring within 24 hours after ictus. Patients were graded according to the World Federation of Neurosurgical Societies (WFNS) scale pre- and postresuscitation and dichotomized into good (WFNS I-III) and poor (WFNS IV-V) grades. Outcome was assessed at 6 months by using the modified Rankin Scale (mRS); an mRS score of 0-3 was considered a good outcome and an mRS score of 4-6 was considered a poor outcome. RESULTS Forty-one of 425 patients with SAH had EOS. Twenty-seven of those 41 patients (65.9%) had a poor WFNS grade. Twenty-eight (68.3%) achieved a good outcome, 11 (26.8%) had a poor outcome, and 2 (4.9%) were lost to followup. Early-onset seizures were proven in 9 of 16 electroencephalograms. The EOS were associated with poor WFNS grade (OR 2.81, 97.5% CI 1.14-7.46; p = 0.03) and good outcome (OR 4.01, 97.5% CI 1.63-10.53; p = 0.03). Increasing age, hydrocephalus, intracerebral hemorrhage, and intraventricular hemorrhage were associated with poor WFNS grade, whereas only age, intracerebral hemorrhage (p < 0.001), and poor WFNS grade (p < 0.001) were associated with poor outcome. CONCLUSIONS Patients with EOS were classified significantly more often in a poor grade initially, but then they significantly more often achieved a good outcome. The authors conclude that EOS can negatively influence grading. This might influence decision making for the care of patients with SAH, so grading of patients with EOS should be interpreted with caution.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Fung, Christian; Murek, Michael; Z'Graggen, Werner Josef; Abu-Isa, Janine; Ozdoba, Christoph; Hänggi, Matthias; Jakob, Stephan; Raabe, Andreas and Beck, Jürgen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3085

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

23 Jan 2015 15:02

Last Modified:

21 Mar 2016 07:47

Publisher DOI:

10.3171/2014.10.JNS14163

PubMed ID:

25479126

Uncontrolled Keywords:

early-onset seizure, modified Rankin Scale, subarachnoid hemorrhage, World Federation of Neurosurgical Societies grade, vascular disorders

BORIS DOI:

10.7892/boris.61856

URI:

https://boris.unibe.ch/id/eprint/61856

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