Department of Neurology, University Medicine Rostock, Germany.
Department of Neurology, University Medicine Rostock, Germany.
J Clin Neurosci. 2019 Dec;70:123-126. doi: 10.1016/j.jocn.2019.08.055. Epub 2019 Aug 16.
Symptomatic epileptic seizures are an important complication in subarachnoid haemorrhage (SAH) with a frequency of 0.9-25% with importance for patient outcome. The majority of previous studies investigated the incidence of symptomatic epileptic seizures after aneurysmatic SAH. Here we compared the seizure incidence and its impact on the outcome between non-aneurysmatic and aneurysmatic SAH.
We analysed retrospectively 109 consecutive patients with spontaneous, non-traumatic SAH. Patients were divided in three groups (perimesencephalic, non-aneurysmatic and aneurysmatic SAH). All patients received standard-of-care treatment. The occurrence of acute (0-7 days after SAH) and remote symptomatic epileptic seizures (7 days or more after SAH), severity of SAH as well as clinical outcome parameters (modified Rankin scale [mRS]) at discharge and the frequency of in-house complications were assessed. mRS scores were dichotomized in 0-3 vs. 4-6 to stratify for good versus bad outcome.
Perimesencephalic SAH patients did not experience acute seizures whereas non-aneurysmatic and aneurysmatic SAH patients showed acute seizures with similar frequency (9% and 11%, p = 0.23). The frequency of remote symptomatic seizures was similar in all subgroups (12% vs. 9% vs. 7%, p = 0.72). Seizure occurrence was not predictive for a poor outcome (mRS >4; acute seizures: OR 0.35 [95%CI: 0.02-6.96], p = 0.49; remote seizures: OR 1.72 [95%CI: 0.14-20.1], p = 0.67).
Seizures are important neurologic complications of SAH of all etiologies. Nevertheless, acute as well as remote symptomatic seizures are unrelated to the short-term outcome. These results should be treated as hypothesis generating and require confirmation.
症状性癫痫发作是蛛网膜下腔出血（SAH）的一个重要并发症，频率为 0.9-25%，对患者预后有重要影响。大多数先前的研究调查了动脉瘤性 SAH 后症状性癫痫发作的发生率。在这里，我们比较了非动脉瘤性和动脉瘤性 SAH 的发作发生率及其对结果的影响。
我们回顾性分析了 109 例连续自发性非创伤性 SAH 患者。患者分为三组（间脑周围、非动脉瘤性和动脉瘤性 SAH）。所有患者均接受标准治疗。评估急性（SAH 后 0-7 天）和远程症状性癫痫发作（SAH 后 7 天或以上）的发生、SAH 的严重程度以及出院时的临床结果参数（改良 Rankin 量表[mRS]）和院内并发症的频率。mRS 评分分为 0-3 分与 4-6 分，以分层良好与不良结局。
间脑周围 SAH 患者无急性发作，而非动脉瘤性和动脉瘤性 SAH 患者急性发作的频率相似（9%和 11%，p=0.23）。所有亚组的远程症状性发作频率相似（12%比 9%比 7%，p=0.72）。发作发生与不良预后无关（mRS >4；急性发作：OR 0.35 [95%CI：0.02-6.96]，p=0.49；远程发作：OR 1.72 [95%CI：0.14-20.1]，p=0.67）。
癫痫发作是所有病因 SAH 的重要神经系统并发症。然而，急性和远程症状性癫痫发作与短期预后无关。这些结果应被视为产生假说的依据，并需要进一步证实。
