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Seizures in Chronic Subdural Hematoma

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Subdural Hematoma

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Abstract

Even though seizure is a well-known complication of chronic subdural hematoma (CSDH), several aspects of this condition remain a matter of debate. The use of appropriate terminology and classification of seizures associated with CSDH is important as it has an impact on the management and prognosis. The incidence of seizures in CSDH is lower overall than in acute subdural hematoma. Different studies have reported several clinical and radiological risk factors for developing a seizure including alcohol abuse, previous stroke, change in mental status, low Glasgow Coma Scale at presentation, mean Glasgow outcome scale by discharge, brain atrophy and mixed density SDH and open craniotomy for treatment. Seizures complicating CSDH can be focal or generalized. Status epilepticus is less frequent and can be subclinical. Electroencephalography is an important tool that provides valuable information for the management of patients with CSDH. Differential diagnosis of seizures in the setting of CSDH includes all the conditions that may cause transient or fluctuating neurological symptoms such as brain injury, NonEpileptic, Stereotypical and Intermittent Symptoms (NESIS) caused by cortical spreading depolarization, Transient ischemia or conditions linked to the disposition of the patient such as hypoglycemia, and abrupt alcohol withdrawal. There is currently no consensual recommendation, and until a consensus has been reached, medications should be weighed against the risks associated with these therapies. Phenytoin is widely used; however, several studies showed that new antiseizure drugs, especially Levetiracetam, were effective with less side effects and drug interactions. Patients with CSDH associated with seizures have a worse outcome, which highlights the importance of the diagnosis and treatment of this condition.

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References

  1. Alkhachroum AM, Fernandez-Baca Vaca G, Sundararajan S, Degeorgia M. Post-subdural hematoma transient ischemic attacks: hypoperfusion mechanism supported by quantitative electroencephalography and transcranial Doppler sonography. Stroke. 2017;48(3):e87–90.

    Article  PubMed  Google Scholar 

  2. Alliez J-R, Balan C, Kaya J-M, Leone M, Reynier Y, Alliez B. Hématome sous-dural chronique de l’adulte. EMC—Neurol. 2007;4(4):1–9.

    Article  Google Scholar 

  3. Banoczi W. ICU-cEEG monitoring. Neurodiagn J. 2020;60(4):231–71.

    Article  PubMed  Google Scholar 

  4. Battaglia F, Lubrano V, Ribeiro-Filho T, Pradel V, Roche PH. Incidence et impact clinique des crises comitiales périopératoires pour les hématomes sous-duraux chroniques. Neurochirurgie. 2012;58(4):230–4.

    Google Scholar 

  5. Beghi E, Carpio A, Forsgren L, Hesdorffer DC, Malmgren K, et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010;51(4):671–5.

    Article  PubMed  Google Scholar 

  6. Beleza P. Acute symptomatic seizures: a clinically oriented review. Neurologist. 2012;18(3):109–19.

    Article  PubMed  Google Scholar 

  7. Bergey GK. Management of a first seizure. Contin Lifelong Learn Neurol. 2016;22:38–50.

    Article  Google Scholar 

  8. Chen CW, Kuo JR, Lin HJ, Yeh CH, Wong BS, et al. Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings. J Clin Neurosci. 2004;11(7):706–9.

    Article  PubMed  Google Scholar 

  9. Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien). 2012;154(9):1541–8.

    Article  Google Scholar 

  10. Driver J, DiRisio AC, Mitchell H, Threlkeld ZD, Gormley WB. Non-electrographic seizures due to subdural hematoma: a case series and review of the literature. Neurocrit Care. 2019;30(1):16–21.

    Article  PubMed  Google Scholar 

  11. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, et al. ILAE Official Report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82.

    Article  PubMed  Google Scholar 

  12. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522–30.

    Article  PubMed  Google Scholar 

  13. Fisher RS, Van Emde Boas W, Blume W, Elger C, Genton P, et al. Response: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) [4]. Epilepsia. 2005;46(10):1701–2.

    Article  Google Scholar 

  14. Gelisse P, Crespel A, Genton P. Atlas of electroencephalography. In: Neurology and critical care. Montrouge: John Libbey Eurotext; 2019. p. 3346.

    Google Scholar 

  15. Grobelny BT, Ducruet AF, Zacharia BE, Hickman ZL, Andersen KN, et al. Preoperative antiepileptic drug administration and the incidence of postoperative seizures following bur hole-treated chronic subdural hematoma: clinical article. J Neurosurg. 2009;111(6):1257–62.

    Article  CAS  PubMed  Google Scholar 

  16. Hesdorffer DC, Benn EKT, Cascino GD, Hauser WA. Is a first acute symptomatic seizure epilepsy? Mortality and risk for recurrent seizure. Epilepsia. 2009;50(5):1102–8.

    Article  PubMed  Google Scholar 

  17. Huang YH, Yang TM, Lin YJ, Tsai NW, Lin WC, et al. Risk factors and outcome of seizures after chronic subdural hematoma. Neurocrit Care. 2011;14(2):253–9.

    Article  PubMed  Google Scholar 

  18. Jankovic SM, Dostic M. Choice of antiepileptic drugs for the elderly: possible drug interactions and adverse effects. Expert Opin Metab Toxicol. 2012;8(1):81–91.

    Google Scholar 

  19. Kaminski HJ, Hlavin ML, Likavec MJ, Schmidley JW. Transient neurologic deficit caused by chronic subdural hematoma. Am J Med. 1992;92(6):698–700.

    Article  CAS  PubMed  Google Scholar 

  20. Khan NR, Vanlandingham MA, Fierst TM, Hymel C, Hoes K, et al. Should levetiracetam or phenytoin be used for posttraumatic seizure prophylaxis? A systematic review of the literature and meta-analysis. Neurosurgery. 2016;79(6):775–81.

    Article  PubMed  Google Scholar 

  21. Kwon TH, Park YK, Lim DJ, Cho TH, Chung YG, et al. Chronic subdural hematoma: evaluation of the clinical significance of postoperative drainage volume. J Neurosurg. 2000;93(5):796–9.

    Article  CAS  PubMed  Google Scholar 

  22. Levesque M, Iorio-Morin C, Bocti C, Vézina C, Deacon C. Nonepileptic, stereotypical, and intermittent symptoms (NESIS) in patients with subdural hematoma: proposal for a new clinical entity with therapeutic and prognostic implications. Neurosurgery. 2020;87(1):96–103.

    Article  PubMed  Google Scholar 

  23. Marcuse LV, Fields MC, Yoo J, Rowan AJ. Rowan’s primer of EEG. 2nd ed. Elsevier; 2016. p. 87–9.

    Google Scholar 

  24. Mohammad LM, Abbas M, Shuttleworth CW, Ahmadian R, Bhat A, et al. Spreading depolarization may represent a novel mechanism for delayed fluctuating neurological deficit after chronic subdural hematoma evacuation. J Neurosurg. 2020;134(3):1294–302.

    Google Scholar 

  25. Nowacki TA, Jirsch JD. Evaluation of the first seizure patient: key points in the history and physical examination. Seizure. 2017;49:54–63.

    Article  PubMed  Google Scholar 

  26. Ohno K, Maehara T, Ichimura K, Suzuki R, Hirakawa K, Monma S. Low incidence of seizures in patients with chronic subdural haematoma. J Neurol Neurosurg Psychiatry. 1993;56(11):1231–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Pichler M, Hocker S. Management of status epilepticus, vol. 140. 1st ed. Elsevier B.V.; 2017. p. 131–51.

    Google Scholar 

  28. Rabinstein AA, Chung SY, Rudzinski LA, Lanzino G. Seizures after evacuation of subdural hematomas: incidence, risk factors, and functional impact: clinical article. J Neurosurg. 2010;112(2):455–60.

    Article  PubMed  Google Scholar 

  29. Radic JAE, Chou SHY, Du R, Lee JW. Levetiracetam versus phenytoin: a comparison of efficacy of seizure prophylaxis and adverse event risk following acute or subacute subdural hematoma diagnosis. Neurocrit Care. 2014;21(2):228–37.

    Article  CAS  PubMed  Google Scholar 

  30. Ratilal BO, Pappamikail L, Costa J, Sampaio C. Anticonvulsants for preventing seizures in patients with chronic subdural haematoma. Cochrane Database Syst Rev. 2013;2013(6):CD004893.

    PubMed Central  Google Scholar 

  31. Reiher J, Rivest J, Maison FG, Leduc CP. Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures. Electroencephalogr Clin Neurophysiol. 1991;78(1):12–7.

    Article  CAS  PubMed  Google Scholar 

  32. Rowe AS, Goodwin H, Brophy GM, Bushwitz J, Castle A, et al. Seizure prophylaxis in neurocritical care: a review of evidence-based support. Pharmacotherapy. 2014;34(4):396–409.

    Article  PubMed  Google Scholar 

  33. Rubin G, Rappaport ZH. Epilepsy in chronic subdural haematoma. Acta Neurochir (Wien). 1993;123:39–42.

    Article  CAS  Google Scholar 

  34. Rudzinski LA, Rabinstein AA. Response to “epileptiform discharges in acute subdural hematoma: to treat or not to treat”. J Clin Neurophysiol. 2012;29(3):287.

    Article  Google Scholar 

  35. Rudzinski LA, Rabinstein AA, Chung SY, Wong-Kisiel LC, Burrus TM, et al. Electroencephalographic findings in acute subdural hematoma. J Clin Neurophysiol. 2011;28(6):633–41.

    Article  PubMed  Google Scholar 

  36. Sabo RA, Hanigan WC, Aldag JC. Chronic subdural hematomas and seizures: the role of prophylactic anticonvulsive medication. Surg Neurol. 1995;43(6):579–82.

    Article  CAS  PubMed  Google Scholar 

  37. Sánchez Fernández I, Gaínza-Lein M, Lamb N, Loddenkemper T. Meta-analysis and cost-effectiveness of second-line antiepileptic drugs for status epilepticus. Neurology. 2019;92(20):E2339–48.

    Article  PubMed  Google Scholar 

  38. Seifi A, Asadi-Pooya AA, Carr K, Maltenfort M, Emami M, et al. The epidemiology, risk factors, and impact on hospital mortality of status epilepticus after subdural hematoma in the United States. Springerplus. 2014;3(1):1–10.

    Article  Google Scholar 

  39. Shihabuddin B, Hinduja A, Yaghi S. Seizures in cerebrovascular disorders. In: Koubeissi MZ et al., editors. Seizures in subdural hematoma. Springer science+business media; 2015. p. 55–69.

    Google Scholar 

  40. Levin S. Psychomotor epilepsy as a manifestation of subdural hematoma. Am J Psychiatry. 1951;107(7):501–2.

    Google Scholar 

  41. Song Y, Cao C, Xu Q, Gu S, Wang F, et al. Piperine attenuates TBI-induced seizures via inhibiting cytokine-activated reactive astrogliosis. Front Neurol. 2020;11:431.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Spoelhof B, Sanchez-Bautista J, Zorrilla-Vaca A, Kaplan PW, Farrokh S, et al. Impact of antiepileptic drugs for seizure prophylaxis on short and long-term functional outcomes in patients with acute intracerebral hemorrhage: a meta-analysis and systematic review. Seizure. 2019;69:140–6.

    Article  PubMed  Google Scholar 

  43. Taş YÇ, Solaroğlu İ, Gürsoy-Özdemir Y. Spreading depolarization waves in neurological diseases: a short review about its pathophysiology and clinical relevance. Curr Neuropharmacol. 2018;17(2):151–64.

    Article  Google Scholar 

  44. Westmoreland BF. Periodic lateralized epileptiform discharges after evacuation of subdural hematomas. J Clin Neurophysiol. 2001;18(1):20–4.

    Article  CAS  PubMed  Google Scholar 

  45. Won SY, Dubinski D, Eibach M, Gessler F, Herrmann E, et al. External validation and modification of the Oslo grading system for prediction of postoperative recurrence of chronic subdural hematoma. Neurosurg Rev. 2021;44(2):961–70.

    Article  PubMed  Google Scholar 

  46. Won SY, Dubinski D, Freiman T, Seifert V, Gessler F, et al. Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment? Eur J Trauma Emerg Surg. 2020. https://doi.org/10.1007/s00068-020-01508-9.

  47. Won SY, Dubinski D, Herrmann E, Cuca C, Strzelczyk A, et al. Epileptic seizures in patients following surgical treatment of acute subdural hematoma—incidence, risk factors, patient outcome, and development of new scoring system for prophylactic antiepileptic treatment (GATE-24 score). World Neurosurg. 2017;101:416–24.

    Article  PubMed  Google Scholar 

  48. Won SY, Dubinski D, Sautter L, Hattingen E, Seifert V, et al. Seizure and status epilepticus in chronic subdural hematoma. Acta Neurol Scand. 2019;140(3):194–203.

    Article  PubMed  Google Scholar 

  49. Won SY, Konczalla J, Dubinski D, Cattani A, Cuca C, et al. A systematic review of epileptic seizures in adults with subdural haematomas. Seizure. 2017;45:28–35.

    Article  PubMed  Google Scholar 

  50. Yamada T. Evaluation of seizures in patients with chronic subdural hematoma treated by Burr-hole surgery and risk factors for seizures. Int J Brain Disord Treat. 2017;3(1):1–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurophysiology, Mohammed V Teaching Military Hospital, Mohammed V University in Rabat, Rabat, Morocco

    Amal Satté & Jamal Mounach

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  1. Amal Satté
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Editors and Affiliations

  1. Department of Neurosurgery, Aydın Adnan Menderes University, Faculty of Medicine, Efeler, Aydın, Turkey

    Mehmet Turgut

  2. Avicenne Military Hospital of Marrakech Department of Neurosurgery, Mohammed V University in Rabat, Rabat, Morocco

    Ali Akhaddar

  3. Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA

    Walter A. Hall

  4. Department of Radiology, Yüksek İhtisas University Faculty of Medicine, Balgat, Ankara, Turkey

    Ahmet T. Turgut

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Satté, A., Mounach, J. (2021). Seizures in Chronic Subdural Hematoma. In: Turgut, M., Akhaddar, A., Hall, W.A., Turgut, A.T. (eds) Subdural Hematoma. Springer, Cham. https://doi.org/10.1007/978-3-030-79371-5_10

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  • DOI: https://doi.org/10.1007/978-3-030-79371-5_10

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