Predictors and clinical impact of epilepsy after subarachnoid hemorrhage.
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.


CONCLUSIONS
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.
Claassen
J
J
Division of Critical Care Neurology, the Comprehensive Epilepsy Center, Department of Neurology, College of Physicians and Surgeons, School of Public Health, Columbia University, New York, NY, USA.
Peery
S
S
Kreiter
K T
KT
Hirsch
L J
LJ
Du
E Y
EY
Connolly
E S
ES
Mayer
S A
SA
D000203:Activities of Daily Living; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D015984:Causality; D002544:Cerebral Infarction / Q000453:epidemiology; D015897:Comorbidity; D004185:Disability Evaluation; D004827:Epilepsy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006408:Hematoma, Subdural / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D018434:Sickness Impact Profile; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology*