Seizures in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Endovascular Coiling (P3.197)

Objective: To examine the incidence of seizures and utilization of continuous video electroencephalogram (cvEEG) in patients with aneurysmal subarachnoid hemorrhage patients treated with endovascular coiling. Background: Long term observational and self-reporting data have shown higher incidence of seizures in patients treated with surgical clipping versus endovascular coiling. However, data on cvEEG during the acute treatment period is skewed towards patients treated with surgical clipping. Methods: Retrospective chart review from January 2010 through October 2015 was completed on all patients admitted with aneurysmal subarachnoid hemorrhage and treated with endovascular coiling at our hospital. Variables recorded included age, gender, Hunt Hess and modified Fisher scores on admission, Glasgow Coma Scale on discharge from ICU, usage of cvEEG, and EEG reporting of seizure, status epilepticus, clinical seizures, non-convulsive seizures, and non-convulsive status epilepticus. Patients were excluded for age <18, aneurysmal ICH without SAH, and AVM-associated aneurysms. Results: 188 patients met inclusion criteria, 135 with Hunt Hess grade 1-3 (low grade), and 53 with Hunt Hess grade 4-5 (high grade). 70 patients were monitored with cvEEG (37.2[percnt]), and eight patients (4.3[percnt], 11.4[percnt] on cvEEG) had seizures; seven of these patients were high grade (13.2[percnt], 18.4[percnt] on cvEEG), and one was low grade (0.7[percnt], 3.1[percnt] on cvEEG). Of the 8 patients with seizures, four were discharged from the ICU with GCS 3, one with GCS 4-8, two with GCS 9-12, and one with GCS 13-15; five (67.5[percnt]) of these patients died. Conclusions: We are a high volume center for endovascular coiling, and in our experience the incidence of seizure is lower than that reported in the literature, even in high grade patients. Further refinement of current EEG monitoring guidelines, including that for all comatose patients, may be needed for appropriate resource allocation. Seizure onset during the acute period appears to be associated with bad outcomes. Disclosure: Dr. Allen has nothing to disclose. Dr. Fakhar has nothing to disclose. Dr. Forgacs has nothing to disclose. Dr. Boddu has nothing to disclose. Dr. Murthy has nothing to disclose. Dr. Stieg has nothing to disclose. Dr. Gobin has nothing to disclose. Dr. Mangat has nothing to disclose.