Early seizures in intracerebral hemorrhage

Abstract

In patients with spontaneous intracerebral hemorrhage (ICH), the occurrence of early seizures (ES) may be a prognostic marker. Therefore, we aimed to identify incidence, associated factors, and influence on outcome of ES in patients with ICH. Between November 2004 and March 2009, we prospectively recruited 562 consecutive adults with a spontaneous ICH (Prognosis of InTra-Cerebral Hemorrhage cohort). Patients with previous seizures (n = 40) were excluded. ES were defined as seizures occurring within 7 days of stroke onset, and their associated factors were identified with Cox regression. For a subgroup of onset seizures, we used logistic regression. Data influencing outcome (mortality at day 7 and month 6 and functional outcome at month 6) were studied using survival analyses. ES occurred in 71 (14%; 95% confidence interval [CI] 11-17) of 522 patients (274 male; median age 72 years, interquartile range 58-79 years). The only factor associated with ES was cortical involvement of ICH (odds ratio [OR] = 2.06; 95% CI 1.28-3.31). Regarding onset seizures (n = 38) (7%; 95% CI 5-10), associated factors were previous ICH (OR = 4.76; 95% CI 1.53-14.84), cortical involvement (OR = 2.21; 95% CI 1.11-4.43), younger age (OR = 0.97 per 1 year increase; 95% CI 0.95-0.99), and severity of the neurologic deficit at admission (OR = 1.03 per 1 point increase in the National Institutes of Health Stroke Scale score; 95% CI 1.01-1.06). ES did not influence vital or functional outcome. ES are a frequent complication in patients with spontaneous ICH; however, their occurrence does not influence outcome at 6 months.