Department of Neurology (E.H., D.S., J.P., T. Sipi, S.M., T. Sairanen, S.C., R.R., M.K., T.T., A.M.) and Department of Neurosurgery (J.S.), Helsinki University Central Hospital, Helsinki, Finland; Neurology Department, EA 1046, Université Lille Nord de France, CHU Lille, Lille, France (C.R., C.C.); and Departments of Medicine and the Florey, University of Melbourne, Melbourne, Australia (A.M.).
Stroke. 2014 Jul;45(7):1971-6. doi: 10.1161/STROKEAHA.114.004686. Epub 2014 May 29.
Seizures are a common complication of intracerebral hemorrhage (ICH). We developed a novel tool to quantify this risk in individual patients.
Retrospective analysis of the observational Helsinki ICH Study (n=993; median follow-up, 2.7 years) and the Lille Prognosis of InTra-Cerebral Hemorrhage (n=325; 2.2 years) cohorts of consecutive ICH patients admitted between 2004 and 2010. Helsinki ICH Study patients' province-wide electronic records were evaluated for early seizures occurring within 7 days of ICH and among 7-day survivors (n=764) for late seizures (LSs) occurring >7 days from ICH. A Cox regression model estimating risk of LSs was used to derive a prognostic score, validated in the Prognosis of InTra-Cerebral Hemorrhage cohort.
Of the Helsinki ICH Study patients, 109 (11.0%) had early seizures within 7 days of ICH. Among the 7-day survivors, 70 (9.2%) patients developed LSs. The cumulative risk of LSs was 7.1%, 10.0%, 10.2%, 11.0%, and 11.8% at 1 to 5 years after ICH, respectively. We created the CAVE score (0-4 points) to estimate the risk of LSs, with 1 point for each of cortical involvement, age<65 years, volume>10 mL, and early seizures within 7 days of ICH. The risk of LSs was 0.6%, 3.6%, 9.8%, 34.8%, and 46.2% for CAVE scores 0 to 4, respectively. The c-statistic was 0.81 (0.76-0.86) and 0.69 (0.59-0.78) in the validation cohort.
One in 10 patients will develop seizures after ICH. The risk of this adverse outcome can be estimated by a simple score based on baseline variables.
癫痫发作是脑出血（ICH）的常见并发症。我们开发了一种新的工具来量化个体患者的这种风险。
对 2004 年至 2010 年间连续收治的观察性赫尔辛基脑出血研究（n=993；中位随访 2.7 年）和里尔脑出血预后研究（n=325；2.2 年）队列的患者进行回顾性分析。评估赫尔辛基脑出血研究患者全省范围内的电子病历，以确定ICH 后 7 天内发生的早期癫痫发作，并在 7 天幸存者（n=764）中确定ICH 后>7 天发生的晚期癫痫发作（LSs）。使用 Cox 回归模型估计 LSs 的风险，以推导预后评分，并在预后的脑出血研究队列中进行验证。
在赫尔辛基脑出血研究患者中，109 例（11.0%）ICH 后 7 天内发生早期癫痫发作。在 7 天幸存者中，70 例（9.2%）患者发生 LSs。ICH 后 1 至 5 年，LSs 的累积风险分别为 7.1%、10.0%、10.2%、11.0%和 11.8%。我们创建了 CAVE 评分（0-4 分）来估计 LSs 的风险，每有一个皮质受累、年龄<65 岁、体积>10 mL 和 ICH 后 7 天内的早期癫痫发作各计 1 分。CAVE 评分 0 至 4 分的 LSs 风险分别为 0.6%、3.6%、9.8%、34.8%和 46.2%。验证队列中的 C 统计量分别为 0.81（0.76-0.86）和 0.69（0.59-0.78）。
每 10 名患者中就有 1 名会在脑出血后发生癫痫发作。这种不良后果的风险可以通过基于基线变量的简单评分来估计。
