Epilepsy in patients with malignant middle cerebral artery infarcts and decompressive craniectomies
| Autor: | Juan Sahuquillo, Manuel Quintana, Ramon Torné, Manuel Toledo, X. Salas Puig, J. Álvarez Sabín, Estevo Santamarina, M. Riveiro, Lorena Guzmán, María Sueiras |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Decompressive Craniectomy medicine.medical_treatment Kaplan-Meier Estimate Statistics Nonparametric Temporal lobe Epilepsy Young Adult medicine.artery Medicine Humans Stroke Aged Retrospective Studies business.industry Mortality rate Electroencephalography Infarction Middle Cerebral Artery Middle Aged medicine.disease Decompressive Craniectomies Surgery medicine.anatomical_structure Diffusion Magnetic Resonance Imaging Neurology Anesthesia Middle cerebral artery Decompressive craniectomy Anticonvulsants Female Neurology (clinical) business Tomography X-Ray Computed Artery Follow-Up Studies |
| Zdroj: | Epilepsy research. 112 |
| ISSN: | 1872-6844 |
| Popis: | Summary Patients with malignant middle cerebral artery (MCA) infarctions who have undergone craniectomy are susceptible to the development of vascular epilepsy. Our objective was to study the factors that might influence the occurrence of seizures in this group of patients. Materials and methods All patients who developed malignant MCA infarction and had undergone decompressive craniectomy in our center between November 2002 and January 2014 were evaluated. In the subsequent follow-up, we evaluated the clinical outcomes and attempted to identify the factors that were related to the occurrence of seizures. Results We evaluated a total of 80 patients. The median time at which the craniectomy was performed was 40.5h after the stroke. Seizures occurred in 47.5% of all patients. The mortality rate within the first week was 16%, and of those who survived 53.7% developed seizures; 9% of these seizures were acute symptomatic, and 44.8% were remote. The median onset of remote seizures was seven months, and the majority of these were motor seizures with generalization. Notably, the patients with seizures exhibited longer delays from stroke to craniectomy, greater involvements of the temporal lobe and a higher rate of post-craniectomy recanalization of the occluded artery. Regarding the timing of the surgeries, a significantly greater proportion of those who underwent surgery more than 42h after the stroke developed epilepsy ( p =0.004). Logistic regression revealed that only prolonged delay (>42h) independently predicted the development of epilepsy (OR 5.166; IC 95% 1.451–18.389; p =0.011). Conclusions More than half of patients with malignant MCA infarcts who underwent decompressive craniectomy developed epilepsy. The occurrence of seizures in these patients was related to the delay to the performance of the craniectomy. |
| Databáze: | OpenAIRE |
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