title: Seizures and Epileptiform Discharges in Patients With Acute Subdural Hematoma.
abstract: OBJECTIVE
  Subdural hematomas (SDH) are associated with seizures and epileptiform discharges, but little is known about the prevalence and impact of seizures, status epilepticus (SE), and epileptiform discharges on outcomes in patients with isolated acute SDH (aSDH).
  
  
  METHODS
  Continuous EEG reports from 76 adult patients admitted to Rush University Medical Center with aSDH between January 2009 and March 2012 were reviewed. Clinical and radiographic findings, comorbidities, treatment, and outcome parameters, such as mortality, discharge destination, need for tracheostomy/percutaneous endoscopic gastrostomy placement, and length of stay (LOS), were assessed. Univariate and multivariate analyses were performed to assess the impact of clinical seizures, SE, and epileptiform EEG on outcomes.
  
  
  RESULTS
  Of 76 patients with aSDH who underwent EEG monitoring, 74 (97.4%) received antiseizure prophylaxis. Thirty-two (41.1%) patients had seizures, most of which were clinical seizures. Twenty-four (32%) patients had epileptiform EEG findings. Clinical or nonconvulsive SE was diagnosed in 12 (16%) patients. Clinical seizures were not associated with outcome parameters. Epileptiform EEG findings were independently associated with longer hospital LOS (13 vs. 8 days, P = 0.04) and intensive care unit LOS (10 vs. 4 days, P = 0.002). The SE also predicted longer intensive care unit LOS (10 vs. 4 days, P = 0.002). Neither epileptiform EEG nor SE was significantly related to mortality, discharge destination, or need for tracheostomy/percutaneous endoscopic gastrostomy placement.
  
  
  CONCLUSIONS
  Seizures and epileptiform EEG findings are very common in patients with aSDH despite antiseizure prophylaxis. While clinical seizures did not affect outcomes, the presence of epileptiform EEG findings and SE was independently associated with longer intensive care unit LOS and hospital LOS.
authors.affiliation: *Section of Neurocritical Care, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, U.S.A.; Departments of †Neurological Sciences, ‡Neurosurgery, §Internal Medicine, and ‖Anesthesiology, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pollandt
authors.forename: Bichun
authors.initials: B
authors.lastname: Ouyang
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Bleck
authors.forename: Katharina M
authors.initials: KM
authors.lastname: Busl
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015897:Comorbidity; D004569:Electroencephalography; D005260:Female; D020199:Hematoma, Subdural, Acute / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants