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

Yıl 2025, Cilt: 47 Sayı: 6, 951 - 963, 26.09.2025

Hamit Genç , Şükrü Kaleağası

https://doi.org/10.20515/otd.1721991

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

Etik Beyan

Ethics Committee Approval: The Clinical Research Ethics Committee of the University of Mersin approved this study (Decision no: 2018/49, Date: January 2018). The authors declared that it was not considered necessary to get consent from the patients because the study was a retrospective data analysis.

Destekleyen Kurum

The authors declared that this study received no financial support.

Proje Numarası

Decision no:2018/49, Date: January 2018

Teşekkür

We want to thank all patients who participated as subjects in the study for their time and engagement. Also, we appreciate Asena Ayça Özdemir for her valuable support and contribution.

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

Proje Numarası

Decision no:2018/49, Date: January 2018

Kaynakça

• 1. Stam, J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005; 352(17), 1791-8.
• 2. Ferro, J. M., Canhão, P., Stam, J., Bousser, M. G., & Barinagarrementeria, F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004; 35(3), 664-70.
• 3. Gasparini, S., Neri, S., Brigo, F., Cianci, V., Mammì, A., Pascarella, A., et al. Late epileptic seizures following cerebral venous thrombosis: a systematic review and meta-analysis. Neurol Sci. 2022; 43(9), 5229-36.
• 4. Sacco, R. L. Prognosis of stroke. Cerebrovascular Disease: Pathophysiology, Diagnosis, and Management. Malden, Mass: Blackwell Science. 1998; 2, 879-91.
• 5. Otite, F. O., Patel, S., Sharma, R., Khandwala, P., Desai, D., Latorre, J. G., et al. Trends in incidence and epidemiologic characteristics of cerebral venous thrombosis in the United States. Neurology. 2020; 95(16), e2200-13.
• 6. Duman, T., Uluduz, D., Midi, I., Bektas, H., Kablan, Y., Goksel, B. K., et al. A multicenter study of 1144 patients with cerebral venous thrombosis: the VENOST study. J Stroke Cerebrovasc Dis. 2017; 26(8), 1848-57.
• 7. Hiltunen, S., Putaala, J., Haapaniemi, E., & Tatlisumak, T. Long-term outcome after cerebral venous thrombosis: analysis of functional and vocational outcome, residual symptoms, and adverse events in 161 patients. J Neurol. 2016; 263, 477-84.
• 8. Ding, H., Xie, Y., Li, L., Chu, H., Tang, Y., Dong, Q., & Cui, M. Clinical features of seizures after cerebral venous sinus thrombosis and its effect on outcome among Chinese Han population. Stroke Vasc Neurol. 2017; 2(4).
• 9. Ferro, J. M., Correia, M., Pontes, C., Baptista, M. V., & Pita, F. Cerebral vein and dural sinus thrombosis in Portugal: 1980–1998. Cerebrovasc Dis. 2001; 11(3), 177-82.
• 10. Ferro, J. M., Correia, M., Rosas, M. J., Pinto, A. N., & Neves, G. Seizures in cerebral vein and dural sinus thrombosis. Cerebrovasc Dis. 2003; 15(1-2), 78-83.
• 11. Masuhr, F., Busch, M., Amberger, N., Ortwein, H., Weih, M., Neumann, K., et al. Risk and predictors of early epileptic seizures in acute cerebral venous and sinus thrombosis. Eur J Neurol. 2006; 13(8), 852-6.
• 12. Luo, Y., Tian, X., & Wang, X. Diagnosis and treatment of cerebral venous thrombosis: a review. Front Aging Neurosci. 2018; 10, 2.
• 13. Ameri, A., & Bousser, M. G. Cerebral venous thrombosis. Neurol Clin. 1992; 10(1), 87-111.
• 14. Terazzi, E., Mittino, D., Ruda, R., Cerrato, P., Monaco, F., Sciolla, R., et al. Cerebral venous thrombosis: a retrospective multicentre study of 48 patients. J Neurol Sci. 2005; 25, 311-5.
• 15. Canhão, P., Ferro, J. M., Lindgren, A. G., Bousser, M. G., Stam, J., & Barinagarrementeria, F. Causes and predictors of death in cerebral venous thrombosis. Stroke. 2005; 36(8), 1720-5.
• 16. Uluduz, D., Midi, I., Duman, T., Yayla, V., Karahan, A. Y., Afsar, N., et al. Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study. Seizure. 2020; 78, 113-7.
• 17. Koubeissi, M. Z., Alshekhlee, A., & Mehndiratta, P. Seizures in Cerebrovascular Disorders. Springer New York; 2015.
• 18. Wasay, M., Bakshi, R., Bobustuc, G., Kojan, S., Sheikh, Z., Dai, A., & Cheema, Z. Cerebral venous thrombosis: analysis of a multicenter cohort from the United States. J Stroke Cerebrovasc Dis. 2008; 17(2), 49-54.
• 19. Saposnik, G., Barinagarrementeria, F., Brown Jr, R. D., Bushnell, C. D., Cucchiara, B., Cushman, M., et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42(4), 1158-92.
• 20. Blanche MT, Durrheim K., Research in Practice Applied Methods for Sociel Sciences, 2007, page:134
• 21. Kwah, L. K., & Diong, J. National institutes of health stroke scale (NIHSS). J Physiother; 2014.
• 22. Van Swieten, J. C., Koudstaal, P. J., Visser, M. C., Schouten, H., & Van Gijn, J. Interobserver agreement for the as1sessment of handicap in stroke patients. Stroke. 1988; 19(5), 604-7.
• 23. Qiu, Z., Sang, H., Dai, Q., & Xu, G. Endovascular treatments for cerebral venous sinus thrombosis. J Thromb Thrombolysis. 2015; 40, 353-62.
• 24. Silvis, S. M., De Sousa, D. A., Ferro, J. M., & Coutinho, J. M. Cerebral venous thrombosis. Nat Rev Neurol. 2017; 13(9), 555-65.
• 25. Gazioglu, S., Yildirim, A., Kokturk, E. G., Seker, D., Cakmak, V. A., & Velioglu, S. K. Acute seizures in cerebral venous sinus thrombosis: risk factors and prognosis. The Neurologist. 2020; 25(5), 126-30.
• 26. Sha, D. J., Qian, J., Gu, S. S., Wang, L. N., Wang, F., & Xu, Y. Cerebral venous sinus thrombosis complicated by seizures: a retrospective analysis of 69 cases. J Thromb Thrombolysis. 2018; 45, 186-91.
• 27. Gadelha, T., André, C., Jucá, A. A., & Nucci, M. Prothrombin 20210A and oral contraceptive use as risk factors for cerebral venous thrombosis. Cerebrovasc Dis. 2005; 19(1), 49-52.
• 28. Bertina, R. M., Koeleman, B. P., Koster, T., Rosendaal, F. R., Dirven, R. J., de Ronde, H., et al. Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature. 1994; 369(6475), 64-67.
• 29. Mahale, R., Mehta, A., John, A. A., Buddaraju, K., Shankar, A. K., Javali, M., & Srinivasa, R. Acute seizures in cerebral venous sinus thrombosis: what predicts it?. Epilepsy Res. 2016; 123, 1-5.
• 30. Davoudi, V., & Saadatnia, M. Risk factors for remote seizure development in patients with cerebral vein and dural sinus thrombosis. Seizure. 2014; 23(2), 135-9.
• 31. Mehvari Habibabadi, J., Saadatnia, M., & Tabrizi, N. Seizure in cerebral venous and sinus thrombosis. Epilepsia open. 2018; 3(3), 316-22.
• 32. Patsalos, P. N. Pharmacokinetic profile of levetiracetam: toward ideal characteristics. Pharmacol Ther. 2000; 85(2), 77-85.
• 33. Einhäupl, K. M., & Masuhr, F. Cerebral venous and sinus thrombosis–an update. Eur J Neurol. 1994; 1(2), 109-26.
• 34. Ferro, J. M., & Canhão, P. Cerebral venous sinus thrombosis: update on diagnosis and management. Curr Cardiol Rep. 2014; 16, 1-10.
• 35. Ferro, J. M., Canhão, P., Bousser, M. G., Stam, J., & Barinagarrementeria, F. Early seizures in cerebral vein and dural sinus thrombosis: risk factors and role of antiepileptics. Stroke. 2008; 39(4), 1152-8.
• 36. Buccino, G., Scoditti, U., Patteri, I., Bertolino, C., & Mancia, D. Neurological and cognitive long‐term outcome in patients with cerebral venous sinus thrombosis. Acta Neurol Scand. 2003; 107(5), 330-5.
• 37. Willmore, L. J., Sypert, G. W., Munson, J. B., & Hurd, R. W. Chronic focal epileptiform discharges induced by injection of iron into rat and cat cortex. Science. 1978; 200(4349), 1501-3.
• 38. Appenzeller, S., Zeller, C. B., Annichino-Bizzachi, J. M., Costallat, L. T., Deus-Silva, L., Voetsch, B., et al. Cerebral venous thrombosis: influence of risk factors and imaging findings on prognosis. Clin Neurol Neurosurg. 2005; 107(5), 371-8.
• 39. Stolz, E., Rahimi, A., Gerriets, T., Kraus, J., & Kaps, M. Cerebral venous thrombosis: an all or nothing disease?: prognostic factors and long-term outcome. Clin Neurol Neurosurg. 2005; 107(2), 99-107.
• 40. Treatment of Behçet syndrome - UpToDate. Accessed April 04, 2025.