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Predictors and clinical impact of epilepsy after subarachnoid hemorrhage

From the Division of Critical Care Neurology (Drs. Claassen and Mayer, and S. Peery and K.T. Kreiter) and the Comprehensive Epilepsy Center (Drs. Claassen and Hirsch), Department of Neurology, and the Department of Neurosurgery (Drs. Connolly and Mayer), College of Physicians and Surgeons, and the Department of Biostatistics, School of Public Health (Dr. Du), Columbia University, New York, NY.

Address correspondence and reprint requests to Dr. Stephan A. Mayer, Division of Critical Care Neurology, Neurological Institute, 710 West 168th Street, Unit 39, New York, NY 10032; e-mail: sam14{at}columbia.edu

Objective: To determine the frequency, predictors, and impact on outcome of epilepsy developing during the first year after subarachnoid hemorrhage (SAH).

Methods: The authors prospectively analyzed 247 of 431 patients with SAH treated over a period of 5 years who were alive with follow-up at 12 months. Epilepsy was defined as two or more unprovoked seizures after hospital discharge.

Results: New-onset epilepsy occurred in 7% (n = 17) of patients; an additional 4% (n = 10) had only one seizure after discharge. Independent predictors of epilepsy included subdural hematoma (OR 9.9, 95% CI 1.9 to 52.8) and cerebral infarction (OR 3.9, 95% CI 1.4 to 11.3). Unlike those without seizures, patients who developed epilepsy failed to experience functional recovery on the modified Rankin Scale (mRS) between 3 and 12 months after SAH. At 12 months epilepsy was independently associated with severe disability (score 3) on the mRS (OR 10.3, 95% CI 2.5 to 42.0), increased instrumental disability on the Lawton Instrumental Activities of Daily Living scale (OR 4.9; 95% CI 1.1 to 22.2), reduced quality of life on the Sickness Impact Profile (OR 4.5; 95% CI 1.1 to 18.0), and increased state anxiety on the Spielberger Anxiety Inventory (OR 4.8; 95% CI 1.1 to 20.4). Epilepsy was not associated with cognitive impairment, depression, or subjective life satisfaction.

Conclusion: Epilepsy occurred in 7% of patients with SAH, was predicted by subdural hematoma and cerebral infarction, and was associated with poor functional recovery and quality of life. Our findings indicate that focal pathology, rather than diffuse injury from hemorrhage, is the principal cause of epilepsy after SAH.

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