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Frequência de crises epiléticas em doentes submetidos a craniectomia descompressiva após AVC
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Orientador(es)
Resumo(s)
Um AVC classifica-se como maligno quando a presença de edema cerebral condiciona um aumento da pressão intracraniana e herniação cerebral. Nesta situação, a cirurgia descompressiva provou ser life-saving, mas recentemente alguns trabalhos mostraram uma elevada frequência de crises epiléticas em doentes submetidos a este procedimento (44-62%). Contudo, a quantificação deste risco e os fatores que lhe estão associados ainda não foram extensamente investigados. Neste sentido, estudou-se retrospetivamente os doentes submetidos a craniectomia descompressiva após AVC maligno da circulação anterior, internados na Unidade de AVC do CHULN-HSM de janeiro 2006 a março 2019. Nos doentes com e sem crises (sintomáticas agudas e não provocadas) foram comparadas variáveis clínicas (idade, sexo, NIHSS), imagiológicas (ASPECTS, transformação hemorrágica) e neurofisiológicas (atividade epileptiforme intercrítica e crítica). Foram incluídos 57 doentes com uma idade média de 55,8 anos (±11,04), seguidos em média durante 26,31 meses (±28,19). Destes, 17 (29,82%) tiveram crises epiléticas: 6 (10,53%) crises sintomáticas agudas e 12 (21,43%) crises não provocadas. A análise bivariada mostrou uma associação entre a ocorrência de crises não provocadas e a mediana do ASPECTS da 1.ª TC-CE realizada (6 (IIQ 4) no grupo com crises e 2 (IIQ 3) no grupo sem crises, p<0,05). Neste trabalho, a frequência de crises epiléticas após AVC maligno submetido a craniectomia foi elevada, embora inferior à reportado em estudos anteriores, mostrando a importância de o clínico estar alerta para esta complicação. A dimensão do enfarte na admissão hospitalar aparenta ser um fator de risco para a ocorrência de crises não provocadas, ou seja, de epilepsia neste grupo de doentes. Um estudo caso-controlo poderá ser desenhado para melhor isolar fatores de risco associados à realização do procedimento cirúrgico propriamente dito.
A stroke is classified as malignant when there is presence of cerebral edema that causes increased intracranial pressure and cerebral herniation. In this situation, decompressive surgery has proven to be life-saving but recently some studies have shown a high frequency of epileptic seizures in patients undergoing this procedure (44-62%). However, the quantification of this risk and its associated factors have not been extensively investigated. In this regard, patients who underwent decompressive craniectomy after malignant anterior stroke, admitted to the CHULN-HSM stroke unit from January 2006 to March 2019, were retrospectively studied. They were divided into 2 groups – patients with and without seizures (both acute symptomatic and unprovoked) – and clinical (age, gender, NIHSS), imaging (ASPECTS, hemorrhagic transformation) and neurophysiological (interictal and ictal epileptiform activity) variables were compared. A total of 57 eligible patients were obtained, with a mean age of 55.8 years (± 11.04), and a mean follow-up time of 26.31 months (±28,19). Of these, 17 (29.82%, n = 57) had epileptic seizures: 6 (10.53%) acute symptomatic seizures and 12 (21.43%) unprovoked seizures. Bivariate analysis showed an association between the occurrence of unprovoked seizures and the median of the ASPECTS value in the first CT performed (6 (IQR 4) in the group with seizures and 2 (IQR 3) in the group without seizures, p<0.05). In this study, the frequency of epileptic seizures after malignant stroke undergoing craniectomy was high, although lower than that reported in previous studies, showing the importance of the clinician being alert for this complication. The size of infarction at hospital admission appears to be a risk factor for the occurrence of unprovoked seizures, that is, epilepsy in this group of patients. A case-control study may be designed to better isolate risk factors associated with performing the surgical procedure itself.
A stroke is classified as malignant when there is presence of cerebral edema that causes increased intracranial pressure and cerebral herniation. In this situation, decompressive surgery has proven to be life-saving but recently some studies have shown a high frequency of epileptic seizures in patients undergoing this procedure (44-62%). However, the quantification of this risk and its associated factors have not been extensively investigated. In this regard, patients who underwent decompressive craniectomy after malignant anterior stroke, admitted to the CHULN-HSM stroke unit from January 2006 to March 2019, were retrospectively studied. They were divided into 2 groups – patients with and without seizures (both acute symptomatic and unprovoked) – and clinical (age, gender, NIHSS), imaging (ASPECTS, hemorrhagic transformation) and neurophysiological (interictal and ictal epileptiform activity) variables were compared. A total of 57 eligible patients were obtained, with a mean age of 55.8 years (± 11.04), and a mean follow-up time of 26.31 months (±28,19). Of these, 17 (29.82%, n = 57) had epileptic seizures: 6 (10.53%) acute symptomatic seizures and 12 (21.43%) unprovoked seizures. Bivariate analysis showed an association between the occurrence of unprovoked seizures and the median of the ASPECTS value in the first CT performed (6 (IQR 4) in the group with seizures and 2 (IQR 3) in the group without seizures, p<0.05). In this study, the frequency of epileptic seizures after malignant stroke undergoing craniectomy was high, although lower than that reported in previous studies, showing the importance of the clinician being alert for this complication. The size of infarction at hospital admission appears to be a risk factor for the occurrence of unprovoked seizures, that is, epilepsy in this group of patients. A case-control study may be designed to better isolate risk factors associated with performing the surgical procedure itself.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Epilepsia Hemicraniectomia descompressiva AVC isquémico Neurologia