title: Epilepsy after aneurysmal subarachnoid hemorrhage: A population-based, long-term follow-up study.
abstract: OBJECTIVE
  The aim was to elucidate the incidence and risk factors of epilepsy after subarachnoid hemorrhage (SAH) from saccular intracranial aneurysm (sIA) in a population-based cohort.
  
  
  METHODS
  The Kuopio sIA Database (www.uef.fi/ns) includes all unruptured and ruptured sIA cases admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland. The use of prescribed medicines, including reimbursable antiepileptic drugs, has been entered from the Finnish national registries. The cumulative incidence and independent risk factors of epilepsy and death were analyzed in 876 patients with sIA-SAH admitted from 1995 to 2007. The competing risks analysis was used to correctly estimate the probability of epilepsy, because epilepsy and death after sIA-SAH may share risk factors.
  
  
  RESULTS
  The follow-up ended at death (n = 200) or December 31, 2008; median follow-up time was 76 months. Epilepsy was diagnosed in 113 patients in a median of 8 months after sIA-SAH. Cumulative incidence of epilepsy after sIA-SAH was 8% at 1 year and 12% at 5 years. Thirty-three percent of patients with intracerebral hemorrhage (ICH) >15 cm(3) developed epilepsy. In the 876 patients with sIA-SAH, the independent risk factors for epilepsy were ICH >15 cm(3), Hunt and Hess grade III-V, and acute seizures.
  
  
  CONCLUSIONS
  Cumulative incidence of epilepsy is 12% at 5 years. Epilepsy and 12-month mortality after sIA-SAH share poor Hunt and Hess grading as an independent risk factor. Epilepsy in the 2-week survivors of sIA-SAH is predicted by signs of primary injury in the brain tissue, most notably ICH.
authors.affiliation: From Neurosurgery (J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.I.) and Neurology (R.K.), NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurosurgery (A.R.), Tampere University Hospital; and Neurosurgery (J.R.), Turku University Hospital, Finland. jukka.huttunen@kuh.fi.
authors.forename: Jukka
authors.initials: J
authors.lastname: Huttunen
authors.affiliation: From Neurosurgery (J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.I.) and Neurology (R.K.), NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurosurgery (A.R.), Tampere University Hospital; and Neurosurgery (J.R.), Turku University Hospital, Finland.
authors.forename: Mitja I
authors.initials: MI
authors.lastname: Kurki
authors.affiliation: From Neurosurgery (J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.I.) and Neurology (R.K.), NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurosurgery (A.R.), Tampere University Hospital; and Neurosurgery (J.R.), Turku University Hospital, Finland.
authors.forename: Mikael
authors.initials: M
authors.lastname: von Und Zu Fraunberg
authors.affiliation: From Neurosurgery (J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.I.) and Neurology (R.K.), NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurosurgery (A.R.), Tampere University Hospital; and Neurosurgery (J.R.), Turku University Hospital, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Koivisto
authors.affiliation: From Neurosurgery (J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.I.) and Neurology (R.K.), NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurosurgery (A.R.), Tampere University Hospital; and Neurosurgery (J.R.), Turku University Hospital, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Ronkainen
authors.affiliation: From Neurosurgery (J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.I.) and Neurology (R.K.), NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurosurgery (A.R.), Tampere University Hospital; and Neurosurgery (J.R.), Turku University Hospital, Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Rinne
authors.affiliation: From Neurosurgery (J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.I.) and Neurology (R.K.), NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurosurgery (A.R.), Tampere University Hospital; and Neurosurgery (J.R.), Turku University Hospital, Finland.
authors.forename: Juha E
authors.initials: JE
authors.lastname: Jääskeläinen
authors.affiliation: From Neurosurgery (J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.I.) and Neurology (R.K.), NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurosurgery (A.R.), Tampere University Hospital; and Neurosurgery (J.R.), Turku University Hospital, Finland.
authors.forename: Reetta
authors.initials: R
authors.lastname: Kälviäinen
authors.affiliation: From Neurosurgery (J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.I.) and Neurology (R.K.), NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio; Neurosurgery (A.R.), Tampere University Hospital; and Neurosurgery (J.R.), Turku University Hospital, Finland.
authors.forename: Arto
authors.initials: A
authors.lastname: Immonen
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012042:Registries; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*