Abstract
BackgroundEpileptic seizures are common clinical features in patients with acute subdural hematoma (aSDH); however, diagnostic feasibility and therapeutic monitoring remain limited. Surface electroencephalography (EEG) is the major diagnostic tool for the detection of seizures but it might be not sensitive enough to detect all subclinical or nonconvulsive seizures or status epilepticus. Therefore, we have planned a clinical trial to evaluate a novel treatment modality by perioperatively implanting subdural EEG electrodes to diagnose seizures; we will then treat the seizures under therapeutic monitoring and analyze the clinical benefit.MethodsIn a prospective nonrandomized trial, we aim to include 110 patients with aSDH. Only patients undergoing surgical removal of aSDH will be included; one arm will be treated according to the guidelines of the Brain Trauma Foundation, while the other arm will additionally receive a subdural grid electrode. The study’s primary outcome is the comparison of incidence of seizures and time-to-seizure between the interventional and control arms. Invasive therapeutic monitoring will guide treatment with antiseizure drugs (ASDs). The secondary outcome will be the functional outcome for both groups as assessed via the Glasgow Outcome Scale and modified Rankin Scale both at discharge and during 6 months of follow-up. The tertiary outcome will be the evaluation of chronic epilepsy within 2–4 years of follow-up.DiscussionThe implantation of a subdural EEG grid electrode in patients with aSDH is expected to be effective in diagnosing seizures in a timely manner, facilitating treatment with ASDs and monitoring of treatment success. Moreover, the occurrence of epileptiform discharges prior to the manifestation of seizure patterns could be evaluated in order to identify high-risk patients who might benefit from prophylactic treatment with ASDs.Trial registrationClinicalTrials.gov identifier no. NCT04211233.
Highlights
Epileptic seizures are common clinical features in patients with acute subdural hematoma; diagnostic feasibility and therapeutic monitoring remain limited
In a recent systematic review, the mean incidence of seizures in acute subdural hematoma (aSDH) was 28%, whereas one retrospective study focusing on diagnostic electroencephalography (EEG) reported a very high incidence of epileptiform discharges on surface EEG scans in 87% of patients with aSDH
Epileptic seizures and in particular status epilepticus are relevant complications of aSDH associated with poor quality of life and outcome [17,18,19]
Summary
Epileptic seizures are common clinical features in patients with acute subdural hematoma (aSDH); diagnostic feasibility and therapeutic monitoring remain limited. Surface electroencephalography (EEG) is the major diagnostic tool for the detection of seizures but it might be not sensitive enough to detect all subclinical or nonconvulsive seizures or status epilepticus. We have planned a clinical trial to evaluate a novel treatment modality by perioperatively implanting subdural EEG electrodes to diagnose seizures; we will treat the seizures under therapeutic monitoring and analyze the clinical benefit. Surface spot EEG is routinely performed to detect seizures; the sensitivity of this approach is limited due to the skin–bone barrier and the short duration of recording. Surface EEG is not always available as a diagnostic tool—for example, during the night or on weekends—which is an additional limitation leading to lengthier time to treatment. Spot surface EEG only records for 20 to 30 min in contrast with continuous EEG recordings which are performed for hours or days
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