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Published on: June 18, 2021
Seizure burden in subarachnoid hemorrhage associated with functional and cognitive outcome
Gian Marco De Marchis1, Deborah Pugin1, Emma Meyers1
1From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Seizure burden on continuous EEG (cEEG) after subarachnoid hemorrhage (SAH) is linked to worse functional and cognitive outcomes. Increased seizure duration predicts higher disability and mortality risk at three months post-SAH.
Area of Science:
- Neuroscience
- Neurology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) is a critical neurological event.
- Assessing post-SAH outcomes is crucial for patient management.
- Continuous EEG (cEEG) monitoring is used in SAH patients.
Purpose of the Study:
- To evaluate the association between seizure burden detected by cEEG and functional/cognitive outcomes at 3 months post-SAH.
- To determine if seizure burden is an independent predictor of outcomes after SAH.
Main Methods:
- Retrospective analysis of 402 spontaneous SAH patients monitored with cEEG.
- Seizure burden quantified as hours of seizures on cEEG.
- Functional and cognitive outcomes assessed at 3 months using disability measures and the Telephone Interview for Cognitive Status (TICS).
Main Results:
- Seizures occurred in 12% of patients (50/402), with a median seizure burden of 6 hours.
- Higher seizure burden on cEEG was significantly associated with unfavorable functional outcomes (OR 1.10 per hour, p=0.04).
- Each hour of seizure activity correlated with a decrease in TICS scores (adjusted coefficient -0.19, p=0.01), indicating cognitive impairment.
Conclusions:
- Seizure burden on cEEG is a significant predictor of poor functional outcome and cognitive impairment 3 months after SAH.
- These findings highlight the importance of monitoring and managing seizures in SAH patients.
- Seizure burden provides valuable prognostic information beyond established SAH predictors.
Objective:
To assess the relationship between seizure burden on continuous EEG (cEEG) and functional as well as cognitive outcome 3 months after subarachnoid hemorrhage (SAH).
Methods:
The study included all consecutive patients with a spontaneous SAH admitted to the Columbia University Medical Center Neurological Intensive Care Unit and monitored with cEEG between 1996 and 2013. Seizure burden was defined as the duration, in hours, of seizures on cEEG. Cognitive outcomes were measured with the Telephone Interview for Cognitive Status (TICS, ranging from 0 to 51, indicating poor to good global mental status).
Results:
Overall, 402 patients with SAH were included with a median age of 58 years (interquartile range [IQR] 46-68 years). The median duration of cEEG monitoring was 96 hours (IQR 48-155 hours). Seizures were recorded in 50 patients (12%), in whom the median seizure burden was 6 hours (IQR 1-13 hours). At 3 months, in multivariate analysis, seizure burden was associated with unfavorable functional and cognitive outcome. Every hour of seizure on cEEG was associated with an odds ratio of 1.10 (95% confidence interval [CI] 1.01-1.21, p = 0.04) to 3-month disability and mortality, and the TICS-score decreased, on average, by 0.16 points (adjusted coefficient -0.19, 95% CI -0.33 to -0.05, p = 0.01).
Conclusion:
In this study, after adjusting for established predictors, seizure burden was associated with functional outcome and cognitive impairment 3 months after SAH.
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