蛛网膜下腔出血患者的发作与动脉瘤治疗方式的相关性。
Association of Seizure Occurrence with Aneurysm Treatment Modality in Aneurysmal Subarachnoid Hemorrhage Patients.
机构信息
Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Department of Neurology, Weill Cornell Medicine, 525 East 68 Street, F-610, New York, NY, 10065, USA.
出版信息
Neurocrit Care. 2018 Aug;29(1):62-68. doi: 10.1007/s12028-018-0506-z.
BACKGROUND
Data on new-onset seizures after treatment of aneurysmal subarachnoid hemorrhage (aSAH) patients are limited and variable. We examined the association between new-onset seizures after aSAH and aneurysm treatment modality, as well their relationship with initial clinical severity of aSAH and outcomes.
METHODS
This is a retrospective cohort study of all aSAH patients admitted to our institution over a 6-year period. 'Seizures' were defined as any observed clinical seizure or electrographic seizure on continuous electroencephalogram (cEEG) recordings, as determined by the reviewing neurophysiologist. Subgroup analyses were performed in low-grade (Hunt-Hess 1-3) and high-grade (Hunt-Hess 4-5) patients. Outcomes measures were Glasgow Coma Score (GCS) at intensive care unit (ICU) discharge and modified Rankin Scale (mRS) at outpatient follow-up.
RESULTS
There were 282 patients with aSAH; 203 (72.0%) suffered low-grade and 79 (28%) high-grade aSAH. Patients were treated with endovascular coiling (N = 194, 68.8%) or surgical clipping (N = 66, 23.4%). Eighteen (6.4%) patients had seizures, of whom 10 (5.5%) had aneurysm coiling and 7 (10.6%) underwent clipping (p = 0.15). In low-grade patients, seizures occurred less frequently (p = 0.016) and were more common after surgical clipping (p = 0.0089). Seizures correlated with lower GCS upon ICU discharge (p < 0.001), in clipped (p = 0.011) and coiled (p < 0.001) patients and in low-grade aSAH (p < 0.001). Seizures correlated with higher mRS on follow-up (p < 0.001), in clipped (p = 0.032) and coiled (p = 0.004) patients and in low-grade aSAH (p = 0.003).
CONCLUSIONS
New-onset seizures after aSAH occurred infrequently, and their incidence after aneurysm clipping versus coiling was not significantly different. However, in low-grade patients, new seizures were more frequently associated with clipping than coiling. Additionally, non-convulsive seizures did not occur in low-grade patients treated with coiling. These findings may explain, in part, previous work suggesting better outcomes in coiled patients and encourage physicians to have a lower threshold for cEEG utilization in low-grade patients suspected to have acute seizures after surgical clipping.
背景
关于治疗颅内动脉瘤性蛛网膜下腔出血（aSAH）患者后新发癫痫的资料有限且各不相同。我们研究了 aSAH 患者治疗后新发癫痫与治疗方式的关系，以及其与初始 aSAH 临床严重程度和结局的关系。
方法
这是一项对 6 年内我院收治的所有 aSAH 患者进行的回顾性队列研究。“癫痫发作”定义为观察到的任何临床发作或连续脑电图（cEEG）记录中的电发作，由审查神经生理学家确定。对低级别（Hunt-Hess 1-3 级）和高级别（Hunt-Hess 4-5 级）患者进行亚组分析。结局指标为重症监护病房（ICU）出院时的格拉斯哥昏迷评分（GCS）和门诊随访时的改良 Rankin 量表（mRS）。
结果
共纳入 282 例 aSAH 患者，其中 203 例（72.0%）为低级别，79 例（28%）为高级别。患者接受血管内弹簧圈栓塞术（N=194，68.8%）或手术夹闭术（N=66，23.4%）治疗。18 例（6.4%）患者出现癫痫发作，其中 10 例（5.5%）为动脉瘤弹簧圈栓塞，7 例（10.6%）为夹闭（p=0.15）。在低级别患者中，癫痫发作的发生率较低（p=0.016），且夹闭术后更为常见（p=0.0089）。癫痫发作与 ICU 出院时的 GCS 评分较低有关（p<0.001），在夹闭患者（p=0.011）和弹簧圈栓塞患者（p<0.001）以及低级别 aSAH 患者中更为常见（p<0.001）。癫痫发作与随访时的 mRS 评分较高有关（p<0.001），在夹闭患者（p=0.032）和弹簧圈栓塞患者（p=0.004）以及低级别 aSAH 患者中更为常见（p=0.003）。
结论
aSAH 后新发癫痫的发生率较低，其在动脉瘤夹闭与弹簧圈栓塞术后的发生率无显著差异。然而，在低级别患者中，新出现的癫痫发作与夹闭的相关性高于弹簧圈栓塞。此外，在接受弹簧圈栓塞治疗的低级别患者中，没有出现非惊厥性癫痫发作。这些发现可能部分解释了以前的工作表明夹闭治疗患者的结局更好，并鼓励医生在怀疑低级别患者在手术后急性癫痫发作时，降低使用 cEEG 的阈值。
Zotero 插件