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Epileptic seizures in intracerebral haemorrhage
1Department of Neurology, Chang Gung Medical College, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Insights
Seizures and epilepsy are common after intracerebral haemorrhage (ICH), particularly with lobar hematomas. Early seizures predict epilepsy, while late seizures indicate recurrence, impacting patient outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Intracerebral haemorrhage (ICH) is a significant cause of neurological disability.
- Seizures and epilepsy are known complications of ICH, but their incidence and characteristics require further elucidation.
Purpose of the Study:
- To investigate the incidence, clinical features, and outcomes of seizures and epilepsy following intracerebral haemorrhage.
- To identify risk factors and predictors of seizure development and recurrence in ICH patients.
Main Methods:
- Retrospective analysis of 1402 patients with intracerebral haemorrhage.
- Classification of seizures as early (<24 hours) or late (>24 hours) post-ICH.
- Analysis of seizure types, epilepsy development, and mortality based on ICH location and timing of seizures.
Main Results:
- Seizures occurred in 4.6% and epilepsy in 2.5% of ICH patients.
- Lobar hematomas had the highest seizure incidence (32%).
- Early seizures (38 patients) predicted epilepsy development (29%), while late seizures (26 patients) predicted recurrence (93%).
- Mortality was higher in patients with early seizures and deep-seated hematomas.
Conclusions:
- Seizures are a frequent complication of ICH, with lobar hematomas posing the highest risk.
- The timing of seizures post-ICH is crucial in predicting epilepsy development and recurrence.
- Understanding these patterns can guide management and improve outcomes for ICH patients.
Abstract:
Among 1402 patients with intracerebral haemorrhage (ICH), seizures occurred in 64 (4.6%) and epilepsy in 35 (2.5%). Seizure was the first manifestation of ICH in 19 patients (30%). Status epilepticus occurred in 11 patients (17%) and it was the initial presentation of ICH in six (9%). The majority had simple partial seizures that were predominantly focal and motor. There were 38 patients with early seizure and 26 patients with late seizure. Ninety per cent of seizures occurred within one year after ICH. Eleven patients (29%) with early seizure developed epilepsy, whereas 24 patients (93%) with late seizure developed recurrent seizures. The incidence of seizure was 32% for lobar haematoma, 2% respectively for putaminal, thalamic and pontine haemorrhages and 1% for cerebellar haemorrhage. Twenty-six (62%) out of 42 patients with lobar haematomas developed epilepsy. Thirteen patients (34%) with early seizure died within three months after the onset of seizures whereas three patients (12%) with late seizure died within the same period. The majority of patients who died had deep-seated haematomas.