Incidence and Predictors of Late Seizures in Intracerebral Hemorrhages

Abstract

Background and Purpose— To identify incidence and predictors of late seizures (LS, occurring >1 week of stroke) in a cohort of patients with intracerebral hemorrhage (ICH). Methods— Prospective cohort of consecutive adults with spontaneous ICH. Incidence and predictors were identified with Cox regression. We included multivariate analyses on MRI biomarkers (global cortical atrophy, leukoaraiosis, brain microbleeds). Results— Our study population consisted of 325 patients: 54% men, median age 70 years (interquartile range, 58–79). During 778 person-years of follow-up, the incidence rate was 4 new cases/100 person-years (95% confidence interval, 3–6). The median delay between ICH and LS was 9 months (interquartile range, 3–23). The only factor independently associated with the occurrence of LS was a cortical involvement of the ICH (hazard ratio, 2.8; 95% confidence interval, 1.3–6.1). Concerning MRI biomarkers, multivariate analyses found lobar brain microbleeds to be associated with LS (hazard ratio, 2.4; 95% confidence interval, 1.1–5.4), especially if ≥3 (hazard ratio, 2.7; 95% confidence interval, 1.1–6.8). LS were associated with a worse functional outcome after 3 years of follow-up ( P =0.009). Conclusions— LS frequently occur >9 months after ICH onset, imposing a long-term follow-up. The association of lobar brain microbleeds with the risk of LS might suggest a link with the underlying vasculopathy (cerebral amyloid angiopathy).