Early seizures in intracerebral hemorrhage: incidence, associated factors, and outcome

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: ES are a frequent complication in patients with spontaneous ICH; however, their occurrence does not influence outcome at 6 months.