Effect of Epileptiform Abnormality Burden on Neurologic Outcome and Antiepileptic Drug Management After Subarachnoid Hemorrhage

Publication date: Available online 1 September 2018

Source: Clinical Neurophysiology

Author(s): Sahar F. Zafar, Eva N. Postma, Siddharth Biswal, Emily J. Boyle, Sophia Bechek, Kathryn O'Connor, Apeksha Shenoy, Jennifer Kim, Mouhsin S. Shafi, Aman B. Patel, Eric S. Rosenthal, M. Brandon Westover

Abstract

Objective

To quantify the burden of epileptiform abnormalities (EAs) including seizures, periodic and rhythmic activity, and sporadic discharges in patients with aneurysmal subarachnoid hemorrhage (aSAH), and assess the effect of EA burden and treatment on outcomes.

Methods

Retrospective analysis of 136 high-grade aSAH patients. EAs were defined using the American Clinical Neurophysiology Society nomenclature. Burden was defined as prevalence of <1%, 1-9%, 10-49%, 50-89%, and >90% for each 18-24 hour epoch. Our outcome measure was 3-month Glasgow Outcome Score.

Results

47.8% patients had EAs. After adjusting for clinical covariates EA burden on first day of recording and maximum daily burden were associated with worse outcomes. Patients with higher EA burden were more likely to be treated with anti-epileptic drugs (AEDs) beyond the standard prophylactic protocol. There was no difference in outcomes between patients continued on AEDs beyond standard prophylaxis compared to those who were not.

Conclusions

Higher burden of EAs in aSAH independently predicts worse outcome. Although nearly half of these patients received treatment, our data suggest current AED management practices may not influence outcome.

Significance

EA burden predicts worse outcomes and may serve as a target for prospective interventional controlled studies to directly assess the impact of AEDs, and create evidence-based treatment protocols.

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