Late seizures in cerebral venous thrombosis
Mayte Sánchez van Kammen1, Erik Lindgren1, Suzanne M Silvis1
1From the Department of Neurology (M.S.v.K., S.M.S., S.M.Z., J.M.C.), Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Clinical Neuroscience (E.L., J.Z., P.R., T.T., K.J.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology (E.L., J.Z., P.R., T.T., K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (S.H., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Neurology (M.R.H., M.A.), Inselspital, Bern University Hospital and University of Bern, Switzerland; National Institute of Neurology and Neurosurgery Manuel Velasco Suarez (F.S., A.A.), Mexico City, Mexico; Sina Hospital (M.M., M.G.), Hamadan University of Medical Science, Iran; Department of Neurosciences and Mental Health (Neurology) (D.A.d.S., P.C., J.M.F.), Hospital de Santa Maria/CHULN; University of Lisbon (D.A.d.S., P.C., J.M.F.), Portugal; Manchester Centre for Clinical Neurosciences (S.A.-A., M.N.M.P.), Salford Royal NHS Foundation Trust, UK; Department of Neurology (E.E., N.Y.), Istanbul Faculty of Medicine, Istanbul University, Turkey; Neurosciences Department (M.A.B.), Hospital Dr. R.A. Calderón Guardia, CCSS, San José, Costa Rica; and Department of Biomedicine, Neuroscience and Advanced Diagnostics (V.A., P.A.), University of Palermo, Italy.
Insights
Approximately 11% of patients with cerebral venous thrombosis (CVT) experience late seizures (LS) within two years. Intracranial bleeding, acute seizures, and decompressive hemicraniectomy increase LS risk, highlighting the need for epilepsy diagnosis after a first LS event.
Area of Science:
- Neurology
- Vascular Neurology
- Epileptology
Background:
- Cerebral venous thrombosis (CVT) is a rare but serious condition.
- Late seizures (LS) can occur after CVT, impacting patient outcomes.
- Predictors and characteristics of LS following CVT require further investigation.
Purpose of the Study:
- To determine the incidence, clinical features, treatment patterns, and risk factors for late seizures (LS) in patients with cerebral venous thrombosis (CVT).
Main Methods:
- A registry-based study including 1,127 adult patients with CVT from an international consortium.
- Exclusion criteria included prior epilepsy history or less than 8 days of follow-up.
- Multivariable Cox regression analysis was employed to identify predictors of LS, defined as seizures occurring more than 7 days post-CVT diagnosis.
Main Results:
- Over a median follow-up of 2 years, 11% of patients experienced LS, with an incidence rate of 30 per 1,000 person-years.
- Predictors of LS included acute phase status epilepticus (HR 7.0), decompressive hemicraniectomy (HR 4.2), acute seizures (HR 4.1), subdural hematoma (HR 2.3), and intracerebral hemorrhage (HR 1.9).
- Seventy percent of patients with LS had recurrent seizures despite antiepileptic drug treatment.
Conclusions:
- Approximately 1 in 10 CVT patients develop LS within two years.
- Risk factors for LS include baseline intracranial bleeding, acute symptomatic seizures, and decompressive hemicraniectomy.
- The high recurrence rate of LS supports the diagnosis of epilepsy after a first LS event.
Objective:
To examine the incidence, characteristics, treatment, and predictors of late seizures (LS) after cerebral venous thrombosis (CVT), we described these features in a registry of 1,127 patients with CVT.
Methods:
We included consecutive adult patients from an international consortium of 12 hospital-based CVT registries. We excluded patients with a history of epilepsy or with <8 days of follow-up. We defined LS as seizures occurring >7 days after diagnosis of CVT. We used multivariable Cox regression to identify predictors of LS.
Results:
We included 1,127 patients with CVT. During a median follow-up of 2.0 years (interquartile range [IQR] 1.0-6.3), 123 patients (11%) experienced ≥1 LS (incidence rate for first LS 30 per 1,000 person-years, 95% confidence interval [CI] 25-35). Median time to first LS was 5 months (IQR 1-16 months). Baseline predictors of LS included status epilepticus in the acute phase (hazard ratio [HR] 7.0, 95% CI 3.9-12.6), decompressive hemicraniectomy (HR 4.2, 95% CI 2.4-7.3), acute seizure(s) without status epilepticus (HR 4.1, 95% CI 2.5-6.5), subdural hematoma (HR 2.3, 95% CI 1.1-4.9), and intracerebral hemorrhage (HR 1.9, 95% CI 1.1-3.1). Eighty-five patients (70% of patients with LS) experienced a recurrent seizure during follow-up, despite the fact that 94% received antiepileptic drug treatment after the first LS.
Conclusion:
During a median follow-up of 2 years, ≈1 in 10 patients with CVT had LS. Patients with baseline intracranial bleeding, patients with acute symptomatic seizures, and those who underwent decompressive hemicraniectomy were at increased risk of developing LS. The high recurrence risk of LS justifies epilepsy diagnosis after a first LS.
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