Seizures in Cerebral Venous Sinus Thrombosis: Predictive Variables and Their Effect on Clinical Course

Öz

This study aimed to evaluate the effect of epileptic seizures on prognosis and the secondary factors accompanying this in patients with cerebral venous sinus thrombosis (CVST).This study was designed as a retrospective, cross-sectional study conducted between Jan 2007 and Dec 2017. Patients diagnosed with CVST aged 18 years or older who applied to the Neurology Clinic of Mersin University Faculty of Medicine Hospital were included in the study. Patients were divided into two groups: those with and without epileptic seizures, and both groups were evaluated with the modified Rankin Scale (mRS) at 1, 3, 6, and 12 months for 1 year. Epileptic seizures were observed in 35.2% of a total of 71 adults of the included patients in the study; 65.4% of these patients (n=17) were female, and the mean age was 36.8±15.8 years. When the prognoses of CVST patients with and without epileptic seizures were compared, a significant difference was found in terms of prognosis in the first month after discharge (p = 0.025). Severe disability (mRS ≥3) was observed more frequently in patients with epileptic seizures, and this difference was statistically significant (p = 0.022). Poor prognostic factors in CVST patients with epileptic seizures were failure to control seizures within the first 24 hours, presence of motor deficit, superior sagittal sinus involvement, frontal lobe involvement, and vasculitic etiology (Behçet's disease), while good prognostic factors were age <65 and absence of parenchymal involvement. Epileptic seizures do not significantly affect the prognosis in CVST patients after the first month after discharge. However, correct identification of risk factors, early diagnosis, and effective treatment can improve the functionality of patients in both the short and long term, thereby providing a better prognosis.

Anahtar Kelimeler

• Cerebral venous sinus thrombosis
• seizure
• prognosis
• supratentorial involvement
• parenchymal involvement
• age
• mastoiditis
• Behçet’s disease
• focal neurological deficits

Serebral Venöz Sinüs Trombozunda Nöbetler: Tahmini Değişkenler ve Klinik Seyir Üzerindeki Etkileri

Öz

Bu çalışmada serebral venöz sinüs trombozu (SVST) olan hastalarda epileptik nöbetlerin prognoz ve buna eşlik eden ikincil faktörler üzerindeki etkisinin değerlendirilmesi amaçlandı. Bu çalışma Ocak 2007 ile Aralık 2017 tarihleri arasında yürütülen retrospektif, kesitsel bir çalışma olarak tasarlanmıştır. Mersin Üniversitesi Tıp Fakültesi Hastanesi Nöroloji Kliniğine başvuran 18 yaş ve üzeri SVST tanısı almış hastalar çalışmaya dâhil edildi. Hastalar epileptik nöbet geçiren ve geçirmeyen olmak üzere iki gruba ayrıldı ve her iki grup da 1 yıl boyunca 1, 3, 6 ve 12. aylarda modifiye Rankin Ölçeği (mRS) ile değerlendirildi. Çalışmaya dâhil edilen 71 yetişkin hastanın %35,2'sinde epileptik nöbetler gözlendi; bu hastaların %65,4'ü (n=17) kadındı ve yaş ortalamaları 36,8±15,8 yıldı. Epileptik nöbet geçiren ve geçirmeyen SVST hastalarının prognozları karşılaştırıldığında, taburcu olduktan sonraki ilk ayda prognoz açısından anlamlı bir fark bulundu (p=0,025). Epileptik nöbet geçiren hastalarda şiddetli sakatlık (mRS ≥3) daha sık gözlendi ve bu fark istatistiksel olarak anlamlıydı (p = 0,022). Epileptik nöbet geçiren SVST hastalarında kötü prognostik faktörler ilk 24 saat içinde nöbetlerin kontrol altına alınamaması, motor defisit varlığı, superior sagital sinüs tutulumu, frontal lob tutulumu ve vaskülitik etyoloji (Behçet hastalığı) iken, iyi prognostik faktörler <65 yaş ve parankimal tutulumun olmamasıydı. Epileptik nöbetler, taburcu olduktan sonraki ilk aydan sonra SVST hastalarında prognozu önemli ölçüde etkilemez. Ancak risk faktörlerinin doğru tanımlanması, erken tanı ve etkili tedavi, daha iyi bir prognoz sağlamak için hastaların kısa ve uzun vadede işlevselliğini iyileştirebilir.

Anahtar Kelimeler

• Serebral venöz sinüs trombozu
• epileptik nöbet
• prognoz
• parankimal tutulum
• Behçet hastalığı
• fokal nörolojik defisitler

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