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Seizure and status epilepticus in chronic subdural hematoma
Author(s) -
Won SaeYeon,
Dubinski Daniel,
Sautter Lisa,
Hattingen Elke,
Seifert Volker,
Rosenow Felix,
Freiman Thomas,
Strzelczyk Adam,
Konczalla Juergen
Publication year - 2019
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.13131
Subject(s) - status epilepticus , incidence (geometry) , medicine , epilepsy , cohort , psychiatry , physics , optics
Background Acute symptomatic seizure (ASz) and status epilepticus (SE) are serious conditions associated with poor quality of life, with unfavorable psychosocial and functional outcome. Chronic subdural hematoma (cSDH) is a common neurosurgical disease related to those complications; therefore, we aimed to evaluate incidence, predictors of ASz/SE, and outcome in this cohort. Methods We retrospectively analyzed patient diagnosed cSDH between 2010 and 2017. Beside their incidence of ASz/SE, patient characteristics, symptoms at admission, comorbidities, and all previously published relevant parameters were assessed. Recurrence rate and functional outcome were analyzed at hospital discharge and 90‐day follow‐up. Results A total of 375 patients were included; incidence of ASz was 15.2% and of SE, 1.9%. In the univariate analysis, drainage insertion ( P = 0.004; OR = 0.3) was a significant negative predictor for ASz/SE and multivariate analysis, including all significant parameters, designated GCS ≤13 at admission ( P = 0.09; OR = 1.9), remote stroke ( P = 0.009; OR = 2.9), and recurrence rate within 14 days ( P = 0.001; OR = 3.3; with an incidence of 13%) as independent predictors for ASz/SE. Overall, patients with ASz/SE had significantly unfavorable outcome at discharge (54.7%; P < 0.001) and follow‐up (39.5%; P < 0.001) with only slight improvement. Late seizures occurred in 3.8% within follow‐up period. Any patient with SE had an unfavorable outcome at discharge without any improvement at follow‐up having a mortality rate of 14.2%. Conclusion Independent predictors for ASz/SE are GCS ≤13 at admission, remote stroke, and recurrent hematoma in patients with cSDH, which is associated with worse functional outcome, particularly those with SE. Due to the higher rate of seizures than recurrence rate, a routine pre‐ and postoperative EEG besides CT is recommended.