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Seizures and Epileptiform Discharges in Patients With Acute Subdural Hematoma

Pollandt, Sebastian; Ouyang, Bichun; Bleck, Thomas P.; Busl, Katharina M.

Journal of Clinical Neurophysiology: January 2017 - Volume 34 - Issue 1 - p 55–60
doi: 10.1097/WNP.0000000000000311
Original Research

Purpose: Subdural hematomas (SDH) are associated with seizures and epileptiform discharges, but little is known about the prevalence and impact of seizures, status epilepticus (SE), and epileptiform discharges on outcomes in patients with isolated acute SDH (aSDH).

Methods: Continuous EEG reports from 76 adult patients admitted to Rush University Medical Center with aSDH between January 2009 and March 2012 were reviewed. Clinical and radiographic findings, comorbidities, treatment, and outcome parameters, such as mortality, discharge destination, need for tracheostomy/percutaneous endoscopic gastrostomy placement, and length of stay (LOS), were assessed. Univariate and multivariate analyses were performed to assess the impact of clinical seizures, SE, and epileptiform EEG on outcomes.

Results: Of 76 patients with aSDH who underwent EEG monitoring, 74 (97.4%) received antiseizure prophylaxis. Thirty-two (41.1%) patients had seizures, most of which were clinical seizures. Twenty-four (32%) patients had epileptiform EEG findings. Clinical or nonconvulsive SE was diagnosed in 12 (16%) patients. Clinical seizures were not associated with outcome parameters. Epileptiform EEG findings were independently associated with longer hospital LOS (13 vs. 8 days, P = 0.04) and intensive care unit LOS (10 vs. 4 days, P = 0.002). The SE also predicted longer intensive care unit LOS (10 vs. 4 days, P = 0.002). Neither epileptiform EEG nor SE was significantly related to mortality, discharge destination, or need for tracheostomy/percutaneous endoscopic gastrostomy placement.

Conclusions: Seizures and epileptiform EEG findings are very common in patients with aSDH despite antiseizure prophylaxis. While clinical seizures did not affect outcomes, the presence of epileptiform EEG findings and SE was independently associated with longer intensive care unit LOS and hospital LOS.

*Section of Neurocritical Care, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, U.S.A.;

Departments of Neurological Sciences,

Neurosurgery,

§Internal Medicine, and

Anesthesiology, Rush University Medical Center, Chicago, Illinois, U.S.A.

Address correspondence and reprint requests to Sebastian Pollandt, MD, Department of Neurological Sciences, Section of Neurocritical Care, Rush University Medical Center, 1725 West Harrison St, POB Suite 1106, Chicago, IL 60612, U.S.A.; e-mail: sebastian_pollandt@rush.edu.

The abstract to this manuscript was presented in form of 2 posters at the Annual Neurocritical Care Society Meeting, Scottsdale, Arizona, October 7–10, 2015.

The authors have no funding or conflicts of interest to disclose.

© 2017 by the American Clinical Neurophysiology Society