title: Seizure burden in subarachnoid hemorrhage associated with functional and cognitive outcome.
abstract: OBJECTIVE
  To assess the relationship between seizure burden on continuous EEG (cEEG) and functional as well as cognitive outcome 3 months after subarachnoid hemorrhage (SAH).
  
  
  METHODS
  The study included all consecutive patients with a spontaneous SAH admitted to the Columbia University Medical Center Neurological Intensive Care Unit and monitored with cEEG between 1996 and 2013. Seizure burden was defined as the duration, in hours, of seizures on cEEG. Cognitive outcomes were measured with the Telephone Interview for Cognitive Status (TICS, ranging from 0 to 51, indicating poor to good global mental status).
  
  
  RESULTS
  Overall, 402 patients with SAH were included with a median age of 58 years (interquartile range [IQR] 46-68 years). The median duration of cEEG monitoring was 96 hours (IQR 48-155 hours). Seizures were recorded in 50 patients (12%), in whom the median seizure burden was 6 hours (IQR 1-13 hours). At 3 months, in multivariate analysis, seizure burden was associated with unfavorable functional and cognitive outcome. Every hour of seizure on cEEG was associated with an odds ratio of 1.10 (95% confidence interval [CI] 1.01-1.21, p = 0.04) to 3-month disability and mortality, and the TICS-score decreased, on average, by 0.16 points (adjusted coefficient -0.19, 95% CI -0.33 to -0.05, p = 0.01).
  
  
  CONCLUSIONS
  In this study, after adjusting for established predictors, seizure burden was associated with functional outcome and cognitive impairment 3 months after SAH.
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: De Marchis
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Deborah
authors.initials: D
authors.lastname: Pugin
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Emma
authors.initials: E
authors.lastname: Meyers
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Angela
authors.initials: A
authors.lastname: Velasquez
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Sureerat
authors.initials: S
authors.lastname: Suwatcharangkoon
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Soojin
authors.initials: S
authors.lastname: Park
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: M Cristina
authors.initials: MC
authors.lastname: Falo
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Sachin
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Stephan
authors.initials: S
authors.lastname: Mayer
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.affiliation: From the Department of Neurology (G.M.D.M., D.P., E.M., A.V., S.S., S.P., M.C.F., S.A., S.M., J.M.S., E.S.C., J.C.), Division of Neurocritical Care, College of Physicians and Surgeons, Columbia University, New York, NY; the Department of Neurology (G.M.D.M.), University Hospital Basel, Switzerland; and the Department of Medicine, Division of Neurology (S.S.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. jc1439@mail.cumc.columbia.edu.
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
mesh_terms: D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012640:Seizures / Q000209:etiology / Q000503:physiopathology*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology*