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Risk factors for seizures after intracerebral hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage

Soo Young Kwon1, Ahmed Z Obeidat2, Padmini Sekar3

  • 1Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35249, USA.

Clinical Neurology and Neurosurgery
|February 17, 2020
PubMed

Insights

Seizures after intracerebral hemorrhage are linked to lobar bleeds, larger volumes, and younger age. The CAVE score effectively predicts seizure risk, with a modified CAVS score also showing strong predictive value.

Area of Science:

  • Neurology
  • Neurosurgery
  • Epidemiology

Background:

  • Intracerebral hemorrhage (ICH) is a serious neurological condition.
  • Seizures are a common complication following ICH, impacting patient outcomes.
  • Predictive tools are needed to identify patients at high risk for post-ICH seizures.

Purpose of the Study:

  • To identify risk factors for seizures after intracerebral hemorrhage.
  • To validate the prognostic value of the CAVE score (cortical involvement, age <65, volume >10 mL, early seizures).
  • To evaluate a modified score (CAVS) incorporating surgical evacuation.

Main Methods:

  • Prospective study (Ethnic/Racial Variations of Intracerebral Hemorrhage - ERICH).
  • Included 2507 patients with spontaneous ICH and no prior seizure history.
  • Univariate and logistic regression analyses were used to determine risk factors and validate scores.

Main Results:

  • Lobar hemorrhage (OR 3.0), larger hematoma volume (OR 1.5/cm³), and surgical evacuation (OR 2.6) increased seizure risk.
  • Younger age was associated with lower risk (OR 0.88 per 5-year increase).
  • The CAVE score strongly predicted seizures (OR 2.5 per unit), as did the CAVS score (OR 2.8 per unit).

Conclusions:

  • Lobar ICH, larger hematoma volume, younger age, and surgical evacuation are significant seizure risk factors.
  • The CAVE score is validated in a multi-ethnic population for predicting post-ICH seizures.
  • The CAVS score offers comparable predictive value and reflects current practices in anti-epileptic drug use.
Abstract

Keywords:
Antiepileptic drugCAVE scoreEpilepsyIntracerebral hemorrhagePost-stroke complicationSeizure

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