Seizures and epilepsy after intracerebral hemorrhage: an update

TL;DR

Seizures are common after intracerebral hemorrhage, especially in the first 72 hours, and may worsen outcomes, but current evidence does not support routine seizure prevention with medication.

Contribution

This review updates current knowledge on seizure incidence, risk factors, and the uncertain impact of seizures on prognosis after intracerebral hemorrhage.

Findings

Seizure incidence reaches 30% with EEG detection.

Risk factors include cortical location and intraventricular hemorrhage.

The benefit of seizure prophylaxis remains unproven.

Abstract

Seizures are common after intracerebral hemorrhage, occurring in 6 to 15% of the patients, mostly in the first 72 hours. Their incidence reaches 30% when subclinical or non-convulsive seizures are diagnosed by continuous electroencephalogram. Several risk factors for seizures have been described including cortical location of intracerebral hemorrhage, presence of intraventricular hemorrhage, total hemorrhage volume, and history of alcohol abuse. Seizures after intracerebral hemorrhage may theoretically be harmful as they can lead to sudden blood pressure fluctuations, increase intracranial pressure and neuronal injury due to increased metabolic demand. Some recent studies suggest that acute symptomatic seizures (occurring within seven days of stroke) are associated with worse functional outcome and increased risk of death despite accounting for other known prognostic factors such as age and baseline hemorrhage volume. However, the impact of seizures on prognosis is still debated and it remains unclear if treating or preventing seizures might lead to improved clinical outcome. Thus, the currently available scientific evidence does not support the routine use of antiseizure medication as primary prevention among patients with intracerebral hemorrhage. Only prospective adequately powered randomized controlled trials will be able to answer whether seizure prophylaxis in the acute or longer term settings is beneficial or not in patients with intracerebral hemorrhage.