Risk factors for seizures after intracerebral hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study

Soo Young Kwon, Ahmed Z. Obeidat, Padmini Sekar, Charles J. Moomaw, Jennifer Osborne, Fernando D. Testai, Sebastian Koch, Merredith R. Lowe, Stacie Demel, Elisheva R. Coleman, Matthew Flaherty, Daniel Woo

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: We aimed to identify risk factors for seizures after intracerebral hemorrhage, and to validate the prognostic value of the previously reported CAVE score (0–4 points: cortical involvement, age <65, volume >10 mL, and early seizures within 7 days of hemorrhage). Patients and methods: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) was a prospective study of spontaneous intracerebral hemorrhage. We included patients who did not have a prior history of seizure and survived to discharge. Univariate analysis and multiple logistic regression modeling were used to identify risk factors for seizure. Results: From 2010–2015, 3000 cases were recruited, and 2507 patients were included in this study. Seizures after hospital discharge developed in 77 patients 3.1 %). Patients with lobar (cortical) hemorrhage (OR 3.0, 95 % CI 1.8–5.0), larger hematoma volume (OR 1.5 per cm3, 95 % CI 1.2–2.0), and surgical evacuation of hematoma (OR 2.6, 95 % CI 1.4–4.8) had a higher risk of late seizure, and older patients had a lower risk (OR 0.88 per 5-year interval increase, 95 % CI 0.81–0.95). The CAVE score was highly associated with seizure development (OR 2.5 per unit score increase, 95 % CI 2.0–3.2, p < 0.0001). The CAVS score, substituting surgical evacuation for early seizure, increased the OR per unit score to 2.8 (95 % CI 2.2–3.5). Conclusions: Lobar hemorrhage, larger hematoma volume, younger age, and surgical evacuation are strongly associated with the development of seizures. We validated the CAVE score in a multi-ethnic population, and found the CAVS score to have similar predictive value while representing the current practice of AED use.

Original languageEnglish (US)
Article number105731
JournalClinical Neurology and Neurosurgery
Volume192
DOIs
StatePublished - May 2020

Keywords

  • Antiepileptic drug
  • CAVE score
  • Epilepsy
  • Intracerebral hemorrhage
  • Post-stroke complication
  • Seizure

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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