Johann Philipp Zöllner1, Jürgen Konczalla2, Marco Stein3, Christian Roth4, Karsten Krakow5, Manfred Kaps6, Helmuth Steinmetz7, Felix Rosenow8, Björn Misselwitz9, Adam Strzelczyk10. 1. Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany. Electronic address: JohannPhilipp.Zoellner@kgu.de. 2. Department of Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany. 3. Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany. 4. Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany; Department of Neurology and Epilepsy Center Hessen, Philipps University Marburg, Marburg (Lahn), Germany. 5. Asklepios Neurologische Klinik Falkenstein, Königstein-Falkenstein, Germany. 6. Department of Neurology, Justus Liebig University Giessen, Giessen, Germany. 7. Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany. 8. Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany. 9. Institute of Quality Assurance Hessen (GQH), Eschborn, Germany. 10. Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Neurology and Epilepsy Center Hessen, Philipps University Marburg, Marburg (Lahn), Germany.
Abstract
BACKGROUND: Risk factors for acute symptomatic seizures after stroke demonstrated in retrospective analyses should be confirmed in large population studies. While seizures following ischemic stroke have been studied intensively, less is known about seizure predictors in hemorrhagic stroke. This study sought to identify risk factors of acute symptomatic seizures and to elucidate associated short-term (in-hospital) morbidity and mortality rates in primary intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). METHODS: We determined the frequency of all acute symptomatic seizures perceived by clinical staff after hemorrhagic stroke in a large population-based registry in a central European region between 2004 and 2016. Further, we analyzed risk factors for seizure occurrence, morbidity, and mortality in univariate and multivariate analyses. RESULTS: Of 297,120 stroke patients, 19,331 experienced a hemorrhagic stroke. Frequency of acute seizures (without semiological differentiation) in this subpopulation was 4% (4.0% in ICH and 3.6% in SAH). The risk for acute symptomatic seizures was significantly increased in both stroke types in the presence of an acute non-neurological infection (odds ratio: 2.0 for ICH and 4.2 for SAH). A lower premorbid functional level also significantly increased the seizure risk (odds ratio: 2.0 for ICH and 3.1 for SAH). The odds of in-hospital mortality in the presence of acute seizures were significantly reduced in ICH patients (odds ratio: 0.7) but not in SAH patients. CONCLUSION: Acute symptomatic seizures are equally common in ICH and SAH patients in this registry. Seizure risk is invariably increased in the presence of acute non-neurological infection. Mortality is reduced in ICH patients with seizures, but the exact reason for this relationship is not clear and might represent a biased finding.
BACKGROUND: Risk factors for acute symptomatic seizures after stroke demonstrated in retrospective analyses should be confirmed in large population studies. While seizures following ischemic stroke have been studied intensively, less is known about seizure predictors in hemorrhagic stroke. This study sought to identify risk factors of acute symptomatic seizures and to elucidate associated short-term (in-hospital) morbidity and mortality rates in primary intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). METHODS: We determined the frequency of all acute symptomatic seizures perceived by clinical staff after hemorrhagic stroke in a large population-based registry in a central European region between 2004 and 2016. Further, we analyzed risk factors for seizure occurrence, morbidity, and mortality in univariate and multivariate analyses. RESULTS: Of 297,120 strokepatients, 19,331 experienced a hemorrhagic stroke. Frequency of acute seizures (without semiological differentiation) in this subpopulation was 4% (4.0% in ICH and 3.6% in SAH). The risk for acute symptomatic seizures was significantly increased in both stroke types in the presence of an acute non-neurological infection (odds ratio: 2.0 for ICH and 4.2 for SAH). A lower premorbid functional level also significantly increased the seizure risk (odds ratio: 2.0 for ICH and 3.1 for SAH). The odds of in-hospital mortality in the presence of acute seizures were significantly reduced in ICHpatients (odds ratio: 0.7) but not in SAHpatients. CONCLUSION: Acute symptomatic seizures are equally common in ICH and SAHpatients in this registry. Seizure risk is invariably increased in the presence of acute non-neurological infection. Mortality is reduced in ICHpatients with seizures, but the exact reason for this relationship is not clear and might represent a biased finding.
Authors: Johann Philipp Zöllner; Björn Misselwitz; Manfred Kaps; Marco Stein; Jürgen Konczalla; Christian Roth; Karsten Krakow; Helmuth Steinmetz; Felix Rosenow; Adam Strzelczyk Journal: Sci Rep Date: 2020-03-02 Impact factor: 4.379
Authors: Johann Philipp Zöllner; Björn Misselwitz; Thomas Mauroschat; Christian Roth; Helmuth Steinmetz; Felix Rosenow; Adam Strzelczyk Journal: Sci Rep Date: 2020-12-03 Impact factor: 4.379
Authors: Johann Philipp Zöllner; Friedhelm C Schmitt; Felix Rosenow; Konstantin Kohlhase; Alexander Seiler; Adam Strzelczyk; Hermann Stefan Journal: Neurol Res Pract Date: 2021-12-06