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Abstract

Objective:

To assess the relationship between seizure burden on continuous EEG (cEEG) and functional as well as cognitive outcome 3 months after subarachnoid hemorrhage (SAH).

Methods:

The study included all consecutive patients with a spontaneous SAH admitted to the Columbia University Medical Center Neurological Intensive Care Unit and monitored with cEEG between 1996 and 2013. Seizure burden was defined as the duration, in hours, of seizures on cEEG. Cognitive outcomes were measured with the Telephone Interview for Cognitive Status (TICS, ranging from 0 to 51, indicating poor to good global mental status).

Results:

Overall, 402 patients with SAH were included with a median age of 58 years (interquartile range [IQR] 46–68 years). The median duration of cEEG monitoring was 96 hours (IQR 48–155 hours). Seizures were recorded in 50 patients (12%), in whom the median seizure burden was 6 hours (IQR 1–13 hours). At 3 months, in multivariate analysis, seizure burden was associated with unfavorable functional and cognitive outcome. Every hour of seizure on cEEG was associated with an odds ratio of 1.10 (95% confidence interval [CI] 1.01–1.21, p = 0.04) to 3-month disability and mortality, and the TICS-score decreased, on average, by 0.16 points (adjusted coefficient −0.19, 95% CI −0.33 to −0.05, p = 0.01).

Conclusion:

In this study, after adjusting for established predictors, seizure burden was associated with functional outcome and cognitive impairment 3 months after SAH.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 86Number 3January 19, 2016
Pages: 253-260
PubMed: 26701381

Publication History

Received: March 19, 2015
Accepted: August 25, 2015
Published online: December 23, 2015
Published in print: January 19, 2016

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Disclosure

G. De Marchis was supported by the following grants: Career Development Grant for junior investigators (PBBEP3_139388) by the Swiss National Science Foundation; Swisslife Jubiläumsstiftung for Medical Research; Swiss Neurological Society; Fondazione Dr. Ettore Balli (Switzerland); peer reviewed De Quervain research grant for young clinical investigators of the Clinical Trial Unit, University of Bern (Switzerland). D. Pugin, E. Meyers, A. Velazquez Novas, S. Suwatcharangkoon, S. Park, M. Falo, S. Agarwal, S. Mayer, J. Schmidt, E. Connolly, and J. Claassen report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Gian Marco De Marchis, MD, MSc
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) Swiss National Science Foundation: Career Development Grant for junior investigators (PBBEP3_139388). (2) Special Program for University Medicine (SPUM-Grant 33CM30-124119) by the Swiss National Science Foundation.
Research Support, Academic Entities:
1.
(1) Clinical Trial Units of the University of Bern (Switzerland), De Quervain research grant for young clinical investigators.
Research Support, Foundations and Societies:
1.
(1) Jubil?umstiftung der Schweizerischen Lebensversicherungs- und Rentenanstalt f?r Volksgesundheit und Medizinische Forschung. (2) Swiss Neurological Society; (3) Fondazione Dr. Ettore Balli (Switzerland)
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Deborah Pugin, MD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
Fond de perfectionnement Geneva University Hospitals
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Emma Meyers, BSc
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
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1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
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1.
NONE
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Angela Velasquez, MD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Sureerat Suwatcharangkoon, MD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
(1) Journal of Thai Stroke Society, Editorial Board Member, 2014-2015
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Soojin Park, MD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
M. Cristina Falo, PhD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Sachin Agarwal, MD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Stephan Mayer, MD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
Actelion Pharmaceuticals Edge Pharmaceuticals Orsan technologies
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Actelion Pharmaceuticals
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Actelion Bard Medical Covidien Edge Therapeutics Orsan Technologies Pfizer Stryker Zoll
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Dana Foundation
Stock/stock Options/board of Directors Compensation:
1.
Orsan Neuroptics
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
J. Michael Schmidt, PhD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Department of Defense, W81XWH-13-1, PI, 2013-2014
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
The Dana Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
E. Sander Connolly, MD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Journal of Neurosurgery, Editorial Board 2010-present, Neurosurgery, Section Editor, 2009-present, World Neurosurgery, Editorial Board, 2010-present
Patents:
1.
Role of P-selectin and Complement in Stroke
Publishing Royalties:
1.
Thieme - Handbook of Neurosurgery
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
FDA/NIH; AHRQ; NIH
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
Defense of JHU for aSAH case - case settled/dismissed.
Jan Claassen, MD, PhD
From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Disclosure
Scientific Advisory Boards:
1.
(1) Actelion (2) SAGE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Editorial board of Neurocritical Care
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Claassen: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Gian Marco De Marchis: study concept and design, acquisition of data, analysis and interpretation of data, drafting the manuscript, critical revision of the manuscript for important intellectual content. Deborah Pugin: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. Emma Meyers: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. Angela Velasquez: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. Sureerat Suwatcharangkoon: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. Soojin Park: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. M. Cristina Falo: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. Sachin Agarwal: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. Stephan Mayer: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. J. Michael Schmidt: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. E. Sander Connolly: acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. Jan Claassen: study concept and design, analysis and interpretation of data, drafting the manuscript, critical revision of the manuscript for important intellectual content.

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