Document Detail


Epilepsy after subarachnoid hemorrhage: the frequency of seizures after clip occlusion or coil embolization of a ruptured cerebral aneurysm: results from the International Subarachnoid Aneurysm Trial.
MedLine Citation:
PMID:  21819189     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The aim of this study was to determine the probability of seizures after treatment of a ruptured cerebral aneurysm by clip occlusion and coil embolization, and to identify the risks and predictors of seizures over the short- and long-term follow-up period.
METHODS: The study population included 2143 patients with ruptured intracranial aneurysms who were enrolled in 43 centers and randomly assigned to clip application or coil placement. Those patients suffering a seizure were identified prospectively at various time points after randomization, as follows: before treatment; after treatment and before discharge; after discharge to 1 year; and annually thereafter.
RESULTS: Two hundred thirty-five (10.9%) of the 2143 patients suffered a seizure after randomization; 89 (8.3%) of 1073 and 146 (13.6%) of 1070 in the endovascular and neurosurgical allocations, respectively (p = 0.014). In 19 patients the seizure was associated with a rehemorrhage. Of those patients who underwent coil placement alone, without additional procedures, 52 suffered a seizure, and in the group with clip occlusion alone, 91 patients suffered a seizure. The risk of a seizure after discharge in the endovascular group was 3.3% at 1 year and 6.4% at 5 years. In the neurosurgical group it was 5.2% at 1 year and 9.6% at 5 years. The risk of seizure was significantly greater in the neurosurgical group at both 2 years and at up to 14 years (p = 0.005 and p = 0.013, respectively). The significant predictors of increased risk were as follows: neurosurgical treatment allocation, hazard ratio (HR) 1.64 (95% CI 1.19-2.26); younger age, HR 1.54 (95% CI 1.14-2.13); Fisher grade > 1 on CT scans, HR 1.34 (95% CI 0.62-2.87); delayed ischemic neurological deficit due to vasospasm, HR 2.10 (95% CI 1.49-2.94); and thromboembolic complication, HR 5.08 (95% CI 3.00-8.61). A middle cerebral artery (MCA) aneurysm location was also a significant predictor of increased risk in both groups; the HR was 2.23 (95% CI 1.57-3.17), with the probability of seizure at 6.1% and 11.5% at 1 year in the endovascular and neurosurgery groups, respectively.
CONCLUSIONS: The risk of seizures after coil embolization is significantly lower than that after clip occlusion. An MCA aneurysm location increased the risk of seizures in both groups.
Authors:
Yvonne Hart; Mary Sneade; Jacqueline Birks; Joan Rischmiller; Richard Kerr; Andrew Molyneux
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-08-05
Journal Detail:
Title:  Journal of neurosurgery     Volume:  115     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-02     Completed Date:  2012-01-25     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1159-68     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN49866681
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MeSH Terms
Descriptor/Qualifier:
Aneurysm, Ruptured / epidemiology*,  etiology
Embolization, Therapeutic / adverse effects,  statistics & numerical data*
Epilepsy / epidemiology*,  etiology
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neurosurgical Procedures / adverse effects,  statistics & numerical data*
Postoperative Complications / epidemiology,  prevention & control
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Risk Factors
Subarachnoid Hemorrhage / epidemiology*,  etiology
Surgical Instruments / statistics & numerical data
Grant Support
ID/Acronym/Agency:
G0700479//Medical Research Council; //Medical Research Council
Comments/Corrections
Comment In:
J Neurosurg. 2011 Dec;115(6):1158; discussion 1158   [PMID:  21819191 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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