title: High Risk of Seizures and Epilepsy after Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke .
abstract: BACKGROUND
  Decompressive hemicraniectomy (DHC) is a life-saving procedure for treatment of large malignant middle cerebral artery (MCA) strokes. Post-stroke epilepsy is an additional burden for these patients, but its incidence and the risk factors for its development have been poorly investigated.
  
  
  OBJECTIVE
  To report the prevalence and risk factors for post-stroke seizures and post-stroke epilepsy after DHC for treatment of large malignant MCA strokes in a cohort of 36 patients.
  
  
  METHODS
  In a retrospective cohort study of 36 patients we report the timing and incidence of post-stroke epilepsy. We analyzed if age, sex, vascular risk factors, side of ischemia, reperfusion therapy, stroke etiology, extension of stroke, hemorrhagic transformation, ECASS scores, National Institutes of Health Stroke Scale (NIHSS) scores, or modified Rankin scores were risk factors for seizure or epilepsy after DHC for treatment of large MCA strokes.
  
  
  RESULTS
  The mean patient follow-up time was 1,086 days (SD = 1,172). Out of 36 patients, 9 (25.0%) died before being discharged. After 1 year, a total of 11 patients (30.6%) had died, but 22 (61.1%) of them had a modified Rankin score ≤4. Thirteen patients (36.1%) developed seizures within the first week after stroke. Seizures occurred in 22 (61.1%) of 36 patients (95% CI = 45.17-77.03%). Out of 34 patients who survived the acute period, 19 (55.9%) developed epilepsy after MCA infarcts and DHC (95% CI = 39.21-72.59%). In this study, no significant differences were observed between the patients who developed seizures or epilepsy and those who remained free of seizures or epilepsy regarding age, sex, side of stroke, presence of the clinical risk factors studied, hemorrhagic transformation, time of craniectomy, and Rankin score after 1 year of stroke.
  
  
  CONCLUSIONS
  The incidence of seizures and epilepsy after malignant MCA infarcts submitted to DHC might be very high. Seizure might occur precociously in patients who are not submitted to anticonvulsant prophylaxis. The large stroke volume and the large cortical ischemic area seem to be the main risk factors for seizure or epilepsy development in this subtype of stroke. .
authors.affiliation: Postgraduate Program in Medicine: Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.|Basic Research and Advanced Investigations in Neurology (B.R.A.I.N.), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.|Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Rosane
authors.initials: R
authors.lastname: Brondani
authors.affiliation: Postgraduate Program in Medicine: Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.|Basic Research and Advanced Investigations in Neurology (B.R.A.I.N.), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.|Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Andrea
authors.initials: A
authors.lastname: Garcia de Almeida
authors.affiliation: Basic Research and Advanced Investigations in Neurology (B.R.A.I.N.), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.|Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Abrahim Cherubini
authors.affiliation: Basic Research and Advanced Investigations in Neurology (B.R.A.I.N.), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.|Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Suelen
authors.initials: S
authors.lastname: Mandelli Mota
authors.affiliation: Division of Neurosurgery, Hospital Mãe de Deus, Porto Alegre, Brazil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: de Alencastro
authors.affiliation: Division of Neurosurgery, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Apio Cláudio Martins
authors.initials: ACM
authors.lastname: Antunes
authors.affiliation: Postgraduate Program in Medicine: Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.|Basic Research and Advanced Investigations in Neurology (B.R.A.I.N.), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.|Division of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.|Center for Treatment of Drug Refractory Epilepsy (CETER), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Marino
authors.initials: M
authors.lastname: Bianchin Muxfeldt
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D056424:Decompressive Craniectomy / Q000009:adverse effects* / Q000401:mortality; D004185:Disability Evaluation; D018572:Disease-Free Survival; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Post-stroke epilepsy ; Risk factors for epilepsy; Risk factors for seizures; Seizure prophylaxis; Stroke