title: Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage.
abstract: OBJECTIVE
  After subarachnoid hemorrhage (SAH), seizure occurs in up to 26% of patients. The impact of seizure on outcome has been studied, yet its impact on grading is unknown. The authors evaluated the impact of early-onset seizures (EOS) on grading of spontaneous SAH and on outcome.
  
  
  METHODS
  This retrospective analysis included consecutive patients with SAH who were treated at the NeuroCenter, Inselspital, University Hospital Bern, Switzerland, between January 2005 and December 2010. Demographic data, clinical data, and reports of EOS were recorded. The EOS were defined as seizures occurring within 24 hours after ictus. Patients were graded according to the World Federation of Neurosurgical Societies (WFNS) scale pre- and postresuscitation and dichotomized into good (WFNS I-III) and poor (WFNS IV-V) grades. Outcome was assessed at 6 months by using the modified Rankin Scale (mRS); an mRS score of 0-3 was considered a good outcome and an mRS score of 4-6 was considered a poor outcome.
  
  
  RESULTS
  Forty-one of 425 patients with SAH had EOS. Twenty-seven of those 41 patients (65.9%) had a poor WFNS grade. Twenty-eight (68.3%) achieved a good outcome, 11 (26.8%) had a poor outcome, and 2 (4.9%) were lost to followup. Early-onset seizures were proven in 9 of 16 electroencephalograms. The EOS were associated with poor WFNS grade (OR 2.81, 97.5% CI 1.14-7.46; p=0.03) and good outcome (OR 4.01, 97.5% CI 1.63-10.53; p=0.03). Increasing age, hydrocephalus, intracerebral hemorrhage, and intraventricular hemorrhage were associated with poor WFNS grade, whereas only age, intracerebral hemorrhage (p<0.001), and poor WFNS grade (p<0.001) were associated with poor outcome.
  
  
  CONCLUSIONS
  Patients with EOS were classified significantly more often in a poor grade initially, but then they significantly more often achieved a good outcome. The authors conclude that EOS can negatively influence grading. This might influence decision making for the care of patients with SAH, so grading of patients with EOS should be interpreted with caution.
authors.affiliation: Department of Neurosurgery.
authors.forename: Christian
authors.initials: C
authors.lastname: Fung
authors.forename: Mathias
authors.initials: M
authors.lastname: Balmer
authors.forename: Michael
authors.initials: M
authors.lastname: Murek
authors.forename: Werner J
authors.initials: WJ
authors.lastname: Z'Graggen
authors.forename: Janine
authors.initials: J
authors.lastname: Abu-Isa
authors.forename: Christoph
authors.initials: C
authors.lastname: Ozdoba
authors.forename: Matthias
authors.initials: M
authors.lastname: Haenggi
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
mesh_terms: D000368:Aged; D002548:Cerebral Revascularization; D004569:Electroencephalography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000145:classification* / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: AED = antiepileptic drug; EEG = electroencephalography; EOS = early-onset seizures; EVD = external ventricular drain; GCS = Glasgow Coma Scale; ICH = intracerebral hemorrhage; IQR = interquartile range; IVH = intraventricular hemorrhage; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies; World Federation of Neurosurgical Societies grade; early-onset seizure; mRS = modified Rankin Scale; modified Rankin Scale; subarachnoid hemorrhage; vascular disorders