title: Immediate, early and late seizures after primary intracerebral hemorrhage.
abstract: BACKGROUND
  Seizures after primary intracerebral hemorrhage (PICH) are significant and treatable complications, but the factors predicting immediate, early and late seizures are poorly known. We investigated characteristics and outcome with special reference to occurrence and timing of a first seizure among consecutive subjects with PICH.
  
  
  METHODS
  A population-based study was conducted in Northern Ostrobothnia, Finland, in 1993-2008 that included all patients with a first-ever primary ICH without any prior diagnosis of epilepsy. Immediate (<24h after admission), early (1-14 days) and late (>2 weeks) seizures were considered separately.
  
  
  RESULTS
  Out of a total of 935 ICH patients, 51 had immediate, 21 early and 58 late seizures. The patients with seizures were significantly younger than the others and more often had a subcortical hematoma location (p<0.05). Lifestyle factors did not differ between the groups. The risk factors for immediate seizures in multivariable analysis were a low Glasgow coma scale score (GCS) on admission, subcortical location and age inversely (p<0.01). The only independent risk factor for early seizures was subcortical location (p<0.001), whereas subcortical location (p<0.001), age inversely (p<0.01) and hematoma evacuation (p<0.05) independently predicted late seizures. Immediate and early seizures predicted infectious complications (p<0.05).
  
  
  CONCLUSIONS
  Patients with subcortical hematoma and of younger age are at risk for immediate seizures after primary ICH irrespective of hematoma size. Patients with immediate and early seizures more often had infectious complications. Surgery increases the risk of a late seizure after ICH.
authors.affiliation: Department of Neurosurgery, Oulu University Hospital, Oulu, Finland. Electronic address: cheng.qian@ppshp.fi.
authors.forename: Cheng
authors.initials: C
authors.lastname: Qian
authors.affiliation: Department of Neurosurgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Löppönen
authors.affiliation: Department of Neurosurgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Sami
authors.initials: S
authors.lastname: Tetri
authors.affiliation: Department of Neurology, Oulu University Hospital, Oulu, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Huhtakangas
authors.affiliation: Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Juvela
authors.affiliation: Department of Neurosurgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Hanna-Maria E
authors.initials: HM
authors.lastname: Turtiainen
authors.affiliation: Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Michaela K
authors.initials: MK
authors.lastname: Bode
authors.affiliation: Department of Neurology, Oulu University Hospital, Oulu, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Hillbom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002543:Cerebral Hemorrhage / Q000150:complications*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012640:Seizures / Q000209:etiology*; D013997:Time Factors
keywords: Epilepsy; Infection; Primary intracerebral hemorrhage; Seizures; Subcortical hematoma