Long-term survival and post-stroke epilepsy after primary intracerebral hemorrhage

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Leena Palotie auditorium 101A (Aapistie 5A). Remote access: https://oulu.zoom.us/j/61812937208?pwd=czhiOVJkSFNaYkE0bHJUY0pzS3dWQT09

Topic of the dissertation

Long-term survival and post-stroke epilepsy after primary intracerebral hemorrhage

Doctoral candidate

Licentiate of medicine Anna-Maija Lahti

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Research Unit of Clinical Neuroscience

Subject of study

Neurosurgery

Opponent

Professor Reetta Kälviäinen, University of Eastern Finland / Kuopio University Hospital

Custos

Docent Sami Tetri, University of Oulu / Oulu university hospital

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Epilepsy and survival after intracerebral hemorrhage

Intracerebral hemorrhage has long been known as a sudden and devastating disease with high early mortality. However, nowadays several people who have succumbed to this illness survive for years after the hemorrhage. Not much has been previously known about the lives and fates of these people, since most research efforts have only concerned the immediate aftermath of the disease. In this dissertation, the main focus was on the mortality and late complications of the long-term survivors of intracerebral hemorrhage. Out of all late complications, epilepsy was the one of primary interest.

During the follow-up lasting a quarter of a century, 81% of patients with intracerebral hemorrhage died. The risk of death remained elevated compared to the general population during the whole follow-up. A new case of intracerebral hemorrhage or other type of stroke was the cause of death in several cases. Thus, paying attention to the conventional stroke risk factors such as hypertension and lifestyle factors is warranted especially in patients who are likely to recover from the initial stages of their intracerebral hemorrhage.

Out of those patients with intracerebral hemorrhage who survived at least three months, 13.5% developed epilepsy. The onset of epilepsy was more likely if a patient’s hemorrhage was located close to the cerebral cortex or if they had seizures during the first days of follow-up. Patients who did not have problems with hypertension prior to the hemorrhage were also at higher risk of developing epilepsy. These groups should be recognized and their higher risk of epilepsy should be kept in mind in order to prevent delays in initiating appropriate treatment.

Those patients who developed epilepsy were at higher risk of death during the follow-up, and they were also more likely to die of pneumonia compared to other patients with intracerebral hemorrhage. This connection has not been shown before in patients with intracerebral hemorrhage. The link between epilepsy and mortality is important for physicians, since it implies that minimizing diagnostic delays by proper follow-up schemes is of importance.

The research project was carried out using a cohort of patients who were living in the catchment area of the Oulu University hospital in 1993 — 2008, and who had their first intracerebral hemorrhage during this period. We also used a group of controls matched by age, sex and more detailed place of residence. Our final patient cohort consisted of 963 patients, and control cohort of 2884 controls.
Last updated: 12.11.2021