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DOI: 10.1055/s-0038-1672202
Seizures and Epilepsy following Subarachnoid Hemorrhage: A Review on Incidence, Risk Factors, Outcome and Treatment
Crises convulsivas e epilepsia após hemorragia subaracnoide: uma revisão sobre incidência, fatores de risco, desfecho e tratamentoPublication History
06 June 2018
10 July 2018
Publication Date:
18 October 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00028832/201803/lookinside/thumbnails/10-1055-s-0038-1672202_1800047-1.jpg)
Abstract
The mortality rates of subarachnoid hemorrhage (SAH) average 51%, and survivors frequently experience acute and long-term neurological conditions, including seizures and epilepsy. The incidence of post SAH-related seizures and epilepsy, its risk factors, outcomes and management are controversial. The present paper aims to discuss these aspects, to provide the pros and cons of different management options of this condition. A review on PubMed was performed encompassing the incidence of seizures and epilepsy following SAH, the risk factors for its occurrence, its related outcomes, and treatment. The incidence of seizures and epilepsy following SAH varies widely in the literature (from 6 to 26%). Some possible risk factors were identified, such as middle cerebral artery (MCA) aneurysm, Hunt and Hess grade III, aneurysm clipping, thick subarachnoid clot, intracerebral hemorrhage, rebleeding, ischemic brain infarction, Fisher grade III or IV, acute hydrocephalus, hypertension history and poor World Federation of Neurosurgical Societies (WFNS) grade. Nevertheless, these relations are frequently uncertain. Also, it appears that the outcome of patients who suffered SAH is worsened by seizures. Given these uncertainties, the need for antiepileptic drug (AED) prophylaxis, the choice of the best drug and dose, as well as the duration of the treatment are controversial topics. However, some recommendations based on low quality evidence are reasonable to be adopted. These include considering AED prophylaxis when a seizure occur after SAH, considering routine long-term AED prophylaxis in specific populations, considering electroencephalogram (EEG) monitoring, and avoiding phenytoin prescription. That is, an individualized approach appears to be the best option, since there is no high-quality evidence.
Resumo
As taxas de mortalidade da hemorragia subaracnoide (HSA) são de 51%, e os sobreviventes frequentemente sofrem condições neurológicas agudas e em longo prazo, incluindo convulsões e epilepsia. A incidência de convulsões e epilepsia após HSA, seus fatores de risco, desfecho e tratamento são controversos. O presente artigo pretende discutir esses aspectos para fornecer os prós e os contras de diferentes opções de manejo dessa condição. Realizou-se uma revisão no PubMed, englobando a incidência de convulsões e epilepsia após HSA, os fatores de risco para a sua ocorrência, seu desfecho e tratamento. A incidência de convulsões e epilepsia após HSA varia amplamente na literatura (de 6 a 26%). Alguns possíveis fatores de risco foram identificados, como aneurisma da artéria cerebral média (ACM), Hunt e Hess grau III, clipagem do aneurisma, coágulo subaracnoide espesso, hemorragia intracerebral, ressangramento, isquemia cerebral, Fisher grau III ou IV, hidrocefalia aguda, história de hipertensão e uma pontuação desfavorável na escala da Federação Mundial de Sociedades de Neurocirurgia (WFNS, na sigla em inglês). Entretanto, essas relações frequentemente são incertas. Além disso, os pacientes que apresentam convulsões após HSA parecem ter pior desfecho. Devido a essas incertezas, a necessidade de profilaxia com anticonvulsivantes, a escolha do melhor fármaco e posologia, e a duração do tratamento são controversos. Contudo, algumas recomendações baseadas em evidências de baixa qualidade podem ser adotadas. Elas incluem considerar profilaxia com anticonvulsivantes para convulsões pós HSA, considerar profilaxia rotineira em longo prazo em populações específicas após HSA, considerar monitoramento com eletroencefalograma (EEG), e evitar a prescrição de fenitoína. Ou seja, uma abordagem individual parece a melhor opção até que haja evidências de alta qualidade.
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