# Influence of epilepsy and antiepileptic drug intake in patients suffering from aneurysmal subarachnoid hemorrhage on outcome

## TL;DR

This study finds that epilepsy after brain aneurysm bleeding worsens recovery, but continued use of seizure drugs may improve outcomes.

## Contribution

The study identifies that continued antiepileptic drug use after seizures in SAH patients is linked to better outcomes, challenging routine administration guidelines.

## Key findings

- Epilepsy after SAH is strongly associated with unfavorable outcomes.
- Continued antiepileptic drug intake after 6 months is a predictor of favorable outcomes.
- Over 40% of SAH patients had poor initial grades, and nearly half had unfavorable outcomes.

## Abstract

Many patients suffering from aneurysmal subarachnoid hemorrhage (SAH) develop epileptic seizures. The recent guidelines do not recommend routine administration of antiepileptic drugs (AED).

We performed a retrospective single-center study to analyze the effect of AEDs on the outcome in patients suffering from epilepsy after SAH.

752 patients with SAH treated between 01/2006 and 12/2020 were analyzed. Patients were divided into good-grade (WFNS grades I-II) versus poor-grade (WFNS grades III-V) on admission. Data of patients’ history as well as clinical course were collected. Outcome according to the modified Rankin scale (mRS) score was assessed at 6 months after ictus. Outcome was dichotomized into favorable (mRS 0–2) and unfavorable (mRS 3–6). Univariate and multivariate analyses were performed.

346 (46.0 %) patients suffered from poor-grade SAH and 366 (48.7 %) patients achieved unfavorable outcome. 202 (26.9 %) patients suffered from seizures after SAH and 136 (18.1 %) had to be treated with antiepileptic drugs (AEDs) for more than a week. Epilepsy and AED intake after 3 months was more often in patients with unfavorable outcome (18.9 % vs. 8.3 %; p < 0.001 and 21.9 % vs. 11.9 %; p < 0.001, respectively).

In multivariate analysis, ‘poor-grade SAH’ (p < 0.001, OR 10.5, 95 % CI 6.0–18.2), ‘age >50 years’ (p = 0.001, OR 2.7, 95 % CI 1.5–4.8, ‘aneurysm size >10 mm’ (p = 0.018, OR 2.2, 95 % CI 1.1–4.1), ‘hydrocephalus’ (p = 0.002, OR 2.6, 95 % CI 1.4–4.7), ‘delayed cerebral ischemia’ (p = 0.002, OR 5.0, 95 % CI 2.3–10.9) and ‘epilepsy within 3 months’ (p = 0.002, OR 5.9, 95 % CI 1.9–18.3) were predictors for unfavorable outcome, whereas ‘AED intake after 6 months’ (p = 0.037, OR 0.35, 95 % CI 0.13–0.94) was predictor for favorable outcome.

Manifestation of epilepsy in patients suffering from SAH deteriorates outcome. Continued AED intake in SAH patients who developed epileptic seizures should be advised.

•Post-SAH epilepsy occurs in about 14 % of patients.•Epilepsy in patients suffering from SAH is associated with unfavorable outcome.•Continued AED intake should be advised in SAH patients who suffer from epilepsy.

Post-SAH epilepsy occurs in about 14 % of patients.

Epilepsy in patients suffering from SAH is associated with unfavorable outcome.

Continued AED intake should be advised in SAH patients who suffer from epilepsy.