title: Epilepsy in patients with malignant middle cerebral artery infarcts and decompressive craniectomies.
abstract: Patients with malignant middle cerebral artery (MCA) infarctions who have undergone craniectomy are susceptible to the development of vascular epilepsy. Our objective was to study the factors that might influence the occurrence of seizures in this group of patients.
  
  
  METHODS
  All patients who developed malignant MCA infarction and had undergone decompressive craniectomy in our center between November 2002 and January 2014 were evaluated. In the subsequent follow-up, we evaluated the clinical outcomes and attempted to identify the factors that were related to the occurrence of seizures.
  
  
  RESULTS
  We evaluated a total of 80 patients. The median time at which the craniectomy was performed was 40.5h after the stroke. Seizures occurred in 47.5% of all patients. The mortality rate within the first week was 16%, and of those who survived 53.7% developed seizures; 9% of these seizures were acute symptomatic, and 44.8% were remote. The median onset of remote seizures was seven months, and the majority of these were motor seizures with generalization. Notably, the patients with seizures exhibited longer delays from stroke to craniectomy, greater involvements of the temporal lobe and a higher rate of post-craniectomy recanalization of the occluded artery. Regarding the timing of the surgeries, a significantly greater proportion of those who underwent surgery more than 42h after the stroke developed epilepsy (p=0.004). Logistic regression revealed that only prolonged delay (>42h) independently predicted the development of epilepsy (OR 5.166; IC 95% 1.451-18.389; p=0.011).
  
  
  CONCLUSIONS
  More than half of patients with malignant MCA infarcts who underwent decompressive craniectomy developed epilepsy. The occurrence of seizures in these patients was related to the delay to the performance of the craniectomy.
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Vall Hebron, Barcelona, Spain; Universitat Autònoma Barcelona (UAB), Barcelona, Spain; Neurotraumatology and Neurosurgery Research Unit (UNINN), University Hospital Vall Hebron, Barcelona, Spain. Electronic address: esantama@vhebron.net.
authors.forename: E
authors.initials: E
authors.lastname: Santamarina
authors.affiliation: Universitat Autònoma Barcelona (UAB), Barcelona, Spain; Neurotraumatology and Neurosurgery Research Unit (UNINN), University Hospital Vall Hebron, Barcelona, Spain; Department of Neurophysiology, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sueiras
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Toledo
authors.affiliation: Department of Neurophysiology, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Guzman
authors.affiliation: Universitat Autònoma Barcelona (UAB), Barcelona, Spain; Neurotraumatology and Neurosurgery Research Unit (UNINN), University Hospital Vall Hebron, Barcelona, Spain; Department of Neurosurgery, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Torné
authors.affiliation: Universitat Autònoma Barcelona (UAB), Barcelona, Spain; Neurotraumatology and Neurosurgery Research Unit (UNINN), University Hospital Vall Hebron, Barcelona, Spain; Department of Intensive Medicine Care, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Riveiro
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Vall Hebron, Barcelona, Spain; Universitat Autònoma Barcelona (UAB), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Quintana
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Salas Puig
authors.affiliation: Universitat Autònoma Barcelona (UAB), Barcelona, Spain; Neurotraumatology and Neurosurgery Research Unit (UNINN), University Hospital Vall Hebron, Barcelona, Spain; Department of Neurosurgery, Hospital Vall Hebron, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sahuquillo
authors.affiliation: Epilepsy Unit, Department of Neurology, Hospital Vall Hebron, Barcelona, Spain; Neurovascular Research Unit, University Hospital Vall Hebron, Barcelona, Spain; Universitat Autònoma Barcelona (UAB), Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Álvarez Sabín
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D056424:Decompressive Craniectomy / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Craniectomy; Malignant stroke; Vascular epilepsy