title: Epileptic Seizures in Patients Following Surgical Treatment of Acute Subdural Hematoma-Incidence, Risk Factors, Patient Outcome, and Development of New Scoring System for Prophylactic Antiepileptic Treatment (GATE-24 score).
abstract: OBJECTIVE
  Clinically evident or subclinical seizures are common manifestations in acute subdural hematoma (aSDH); however, there is a paucity of research investigating the relationship between seizures and aSDH. The purpose of this study is 2-fold: determine incidence and predictors of seizures and then establish a guideline in patients with aSDH to standardize the decision for prophylactic antiepileptic treatment.
  
  
  METHODS
  The author analyzed 139 patients with aSDH treated from 2007 until 2015. Baseline characteristics and clinical findings including Glasgow Coma Scale (GCS) at admission, 24 hours after operation, timing of operation, anticoagulation, and Glasgow Outcome Scale at hospital discharge and after 3 months were analyzed. Multivariate logistic regression analysis was performed to detect independent predictors of seizures, and a scoring system was developed.
  
  
  RESULTS
  Of 139 patients, overall incidence of seizures was 38%, preoperatively 16% and postoperatively 24%. Ninety percent of patients with preoperative seizures were seizure free after operation for 3 months. Independent predictors of seizures were GCS <9 (odds ratio [OR] 3.3), operation after 24 hours (OR 2.0), and anticoagulation (OR 2.2). Patients with seizures had a significantly higher rate of unfavorable outcome at hospital discharge (P = 0.001) and in 3-month follow-up (P = 0.002). Furthermore, a score system (GATE-24) was developed. In patients with GCS <14, anticoagulation, or surgical treatment 24 hours after onset, a prophylactic antiepileptic treatment is recommended.
  
  
  CONCLUSIONS
  Occurrence of seizures affected severity and outcomes after surgical treatment of aSDH. Therefore seizure prophylaxis should be considered in high-risk patients on the basis of the GATE-24 score to promote better clinical outcome.
authors.affiliation: Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany. Electronic address: sae-yeon.won@kgu.de.
authors.forename: Sae-Yeon
authors.initials: SY
authors.lastname: Won
authors.affiliation: Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Dubinski
authors.affiliation: Department of Medicine, Institute of Biostatistics and Mathematical Modelling, University Hospital, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Colleen
authors.initials: C
authors.lastname: Cuca
authors.affiliation: Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, University Hospital, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Adam
authors.initials: A
authors.lastname: Strzelczyk
authors.affiliation: Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.affiliation: Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Konczalla
authors.affiliation: Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Freiman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage*; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D020199:Hematoma, Subdural, Acute / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: Acute subdural hematoma; Epilepsy; Functional outcome; Post-traumatic seizures; Prophylactic antiepileptic treatment; Risk factors