Nonconvulsive seizures and renal failure after intracerebral hemorrhage

Introduction

Nonconvulsive seizures (NCSZ) and periodic epileptiform discharges (PEDs) are common and associated with poor outcome after intracerebral hemorrhage (ICH). Our objective is to describe the frequency of renal, liver, metabolic and thrombotic dysfunction after ICH and its association with non-convulsive status epilepticus (NCSE), NCSZ and PEDs.

Methods

We retrospectively identified all patients with spontaneous ICH who underwent cEEG monitoring between 1998 and 2006. Data assessed included admission creatinine and maximum values during the first 14 days for creatinine and bilirubin, and minimum values for bicarbonate, base excess and platelets. Acute renal failure (ARF) was defined as an increase in creatinine >50% from baseline, and severity was assessed by the RIFLE criteria. Other continuous variables were dichotomized using the mean value as the cutoff point to define the presence of liver dysfunction, acidosis and thrombocytopenia. ICH characteristics were based on CT scans. Univariate logistic regression was conducted to identify associations between predictors and NCSE, NCSZ and PEDs. Significant (P < 0.25) and clinically relevant variables were then included in a multivariable logistic regression model to identify independent associations.

Results

A total of 102 patients were studied. The mean age was 62 ± 17 years and 55 (56%) were male. Twenty-six (26%) patients were comatose on admission and 15 (17%) had an increase in ICH volume >30%. Seven (6%) patients developed NCSE, 18 (18%) NCSZ and 17 presented PEDs. ARF developed in 30 (29%) patients, liver dysfunction in 30 (29%), metabolic dysfunction in 48 (47) and thrombocytopenia in 55 (54%). Patients with NCSZ and PEDs more frequently developed ARF (56 vs. 24%, P = 0.01 and 47 vs. 26%, P = 0.08, respectively). After adjusting for age, gender, coma at admission and increase in ICH volume, patients with ARF were six times more likely to develop NCSZ (OR = 5.9, 95% CI = 1.4 to 24.6, P = 0.01) as compared with those without ARF. Similarly, after adjusting for age, gender and coma/stupor at admission, each one-point increase in the RIFLE criteria doubles the odds of developing PEDs (OR = 2.0, 95% CI = 1.1 to 3.6, P = 0.02). No significant associations were found for NCSE.

Conclusion

ICH location within 1 mm from the cortex, an increase in ICH volume, coma or stupor at admission and the presence of ARF were independently associated with the development of NCSZ and PEDs after ICH.