Authors :
Presenting Author: Vijaya Dasari, MD – Cleveland Clinic
MarieElena Byrnes, DO, MS – Cleveland Clinic
Sakhi Bhansali, MD – Cleveland Clinic
Neishay Ayub, MD – Brown University
Clio Rubinos, MD, MS, FACNS – University of North Carolina, Chapel Hill, North Carolina, USA.
Sahar Zafar, MD, MBBS – Massachusetts General Hospital
Adithya Sivaraju, MD – Yale New Haven Hospital
Vineet Punia, MD – Cleveland Clinic, Cleveland, OH, USA
Rationale:
Acute Symptomatic Seizures (ASyS) account for almost half of all new seizure cases. ASyS also is the most common risk factor for post-acute brain injury epileptogenesis. Yet, there is a dearth of knowledge about factors associated with epilepsy development in patients with ASyS managed during routine clinical practice. Our study aimed to fill this knowledge gap.
Methods:
We performed a retrospective multicenter study from the five centers in the PASSION (Post-Acute Symptomatic Seizure Investigation and Outcomes Network) consortium. Consecutive patients with clinical ASyS and continuous EEG (cEEG) monitoring who survived hospitalization during a 3-month study period in 2021 were included. Data extraction, including post-discharge seizure recurrence and death, was performed uniformly across the participating sites using a standardized operating procedure. Seizure recurrence following hospital discharge was analyzed using the Fine-Gray subdistribution hazard model to account for death as a competing risk. Covariates were selected a priori based on clinical relevance and tested for multicollinearity. Subdistribution hazard ratios (sHRs) with 95% confidence intervals (CIs) were reported. The analysis was performed in R, version 4.3.1. All tests were two-sided, and statistical significance was set at 0.05.Results:
A total of 329 patients (mean age = 59 years, SD = 18.3), including 47% females, were included in the study. Among them, 72% were on ASMs at hospital discharge. A total of 50 (15%) patients had seizure recurrence during the follow-up, and 90 (27%) died. The total study cohort characteristics, stratified by seizure recurrence status, are presented in Table 1. As shown in Figure 1, the cumulative incidence of seizure recurrence at 12, 24, and 36 months after discharge was 11.2%, 13.4%, and 14.3%, respectively, which was outpaced by mortality incidence at each time-point. The Fine-Gray subdistribution hazard model found that younger age was significantly associated with increased seizure recurrence risk (HR = 0.98, 95% CI: 0.96–1.00, p = 0.012). Compared to patients with toxic-metabolic encephalopathy, those with acute brain injury and other etiologies had around three times higher risk of seizure recurrence (HR = 2.99, 95% CI: 1.01–8.80, and HR = 3.44, 95% CI: 1.12–10.51, respectively). Additionally, a higher number of ASMs at discharge, a marker of more difficult-to-control electrographic seizures acutely, was independently associated with greater seizure risk, with each additional ASM corresponding to an 84% increase in hazard (HR = 1.84, 95% CI: 1.27–2.65, p = 0.0011).Conclusions:
In this multicenter ASyS cohort, almost 1 in 7 patients had seizure recurrence after hospital discharge in the context of higher early mortality. Younger age, non-systemic systemic etiologies, including acute brain injury, and difficult-to-control acute electrographic seizures were independently associated with increased recurrence risk. These findings highlight the need for individualized post-discharge risk stratification and may inform decisions regarding ASM duration and closer monitoring based on such risk stratification.Funding: The AES infrastructure award was received.