title: Seizures after aneurysmal subarachnoid hemorrhage treated with coil embolization.
abstract: OBJECTIVE
  We sought to determine the incidence of seizures among patients treated with endovascular coil embolization for ruptured intracranial aneurysms because data on which to base antiepileptic drug (AED) prescriptions and advice to patients regarding driving motor vehicles and other high-risk activities are currently lacking.
  
  
  METHODS
  We conducted a single-institute, single-operator observational study of 243 patients referred for endovascular treatment after aneurysmal subarachnoid hemorrhage. Prospective data collection was performed, and all successfully treated patients were followed. The incidence of seizures was compared with published surgical data, and logistic regression analysis of potential clinical associations was performed. Patients were followed for up to 7.7 years (mean follow-up period, 21.9 mo).
  
  
  RESULTS
  Ictal seizures occurred at the time of subarachnoid hemorrhage in 26 (11%) of 243 patients and correlated with middle cerebral artery aneurysm location, loss of consciousness at ictus, and AED prescription. No patients experienced periprocedural seizures during their hospitalization. Seven of 233 successfully treated patients (3%) experienced seizures more than 30 days after treatment: late seizures occurred de novo in four patients (1.7%) and in three patients (1.4%) were caused by preexisting epilepsy. Two patients (0.85%) who had de novo seizures developed epilepsy. Late seizures correlated with a history of previous seizures, the presence of a cerebrospinal fluid shunt, and the use of AEDs.
  
  
  CONCLUSIONS
  The low incidence of seizures does not justify the use of prophylactic AED therapy after aneurysmal subarachnoid hemorrhage in patients treated solely with coil embolization, nor does it justify subsequent restrictions on the driving of motor vehicles if the patient is otherwise fit to drive.
authors.affiliation: Department of Radiology, Radcliffe Infirmary, Oxford, England. james.byrne@radiology.ox.ac.uk
authors.forename: James V
authors.initials: JV
authors.lastname: Byrne
authors.forename: Philip
authors.initials: P
authors.lastname: Boardman
authors.forename: Ioannis
authors.initials: I
authors.lastname: Ioannidis
authors.forename: Jane
authors.initials: J
authors.lastname: Adcock
authors.forename: Zoe
authors.initials: Z
authors.lastname: Traill
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage* / Q000627:therapeutic use*; D001334:Automobile Driving; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012640:Seizures / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D013345:Subarachnoid Hemorrhage / Q000628:therapy*; D013997:Time Factors
chemical_list: D000927:Anticonvulsants