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Abstract
Background and Objectives Epilepsy in patients with brain abscess is frequent, but risk factors and prognosis remain undetermined. This study examined risk factors of epilepsy among survivors of brain abscess and associated prognosis.
Methods Nationwide, population-based healthcare registries were used to compute cumulative incidences and cause-specific adjusted hazard rate ratios (adj. HRRs) with 95% CIs for epilepsy among 30-day survivors of brain abscess from 1982 through 2016. Data were enriched with clinical details by medical record review of patients hospitalized from 2007 through 2016. Adjusted mortality rate ratios (adj. MRRs) were examined using epilepsy as a time-dependent variable.
Results The study included 1,179 30-day survivors of brain abscess among whom 323 (27%) developed new-onset epilepsy after a median of 0.76 years (interquartile range [IQR] 0.24–2.41). At admission for brain abscess, the median age was 46 years (IQR 32–59) in patients with epilepsy compared with 52 years (IQR 33–64) in those without epilepsy. The proportion of female individuals was similar in patients with and without epilepsy (37%). Adj. HRRs for epilepsy were 2.44 (95% CI 1.89–3.15) for aspiration or excision of brain abscess, 2.37 (1.56–3.60) for alcohol abuse, 1.75 (1.27–2.40) for previous neurosurgery or head trauma, 1.62 (1.17–2.25) for stroke, and 1.55 (1.04–2.32) for age group 20–39 years. Cumulative incidences were increased in patients with alcohol abuse (52% vs 31%), aspiration or excision of brain abscess (41% vs 20%), previous neurosurgery or head trauma (41% vs 31%), and stroke (46% vs 31%). Analysis using clinical details from medical record review of patients from 2007 through 2016 demonstrated adj. HRRs of 3.70 (2.24–6.13) for seizures at admission for brain abscess and 1.80 (1.04–3.11) for frontal lobe abscess. By contrast, adj. HRR was 0.42 (0.21–0.86) for occipital lobe abscess. Using the entire registry-based cohort, patients with epilepsy had an adj. MRR of 1.26 (1.01–1.57).
Discussion Important risk factors of epilepsy were seizures during admission for brain abscess, neurosurgery, alcoholism, frontal lobe abscess, and stroke. Epilepsy was associated with an increased mortality. Antiepileptic treatment may be guided by individual risk profiles, and a specialized follow-up is highlighted by an increased mortality in survivors with epilepsy.
Glossary
- adj. HRR=
- adjusted hazard rate ratio;
- CRS=
- Civil Registration System;
- DNPR=
- Danish National Patient Registry;
- ICD=
- International Classification of Diseases;
- IQR=
- interquartile range;
- IRs=
- incidence rates;
- MRR=
- mortality rate ratio;
- PPV=
- positive predictive value;
- SUDEP=
- sudden unexpected death in epilepsy
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Associate Editor Rebecca Burch, MD.
- Received September 14, 2022.
- Accepted in final form December 13, 2022.
- © 2023 American Academy of Neurology
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