Epilepsy after Ruptured Intracranial Aneurysm

Abstract

A total of 1,009 cases of ruptured intracranial aneurysm have been studied; epileptic attacks occurred in 53 (10.4%) of the 508 survivors. The incidence was 14.8% when a small sample was examined personally. Fits were more likely to occur in the younger age-group, when the aneurysm was situated on the middle cerebral artery, and in the presence of an intracerebral haematoma. Patients with residual signs of brain damage seemed to be particularly at risk. The fits were usually of the grand-mal type, but focal or temporal-lobe epilepsy also occurred, and different types of fit were occasionally seen in the same patient. Five patients had their first fit more than 18 months after the aneurysm had ruptured. At the time of the first fit 80% of the epileptics were not taking anticonvulsants. In most cases the fits were few in number and were well controlled with anticonvulsant therapy. Phenobarbitone, 30 mg. b.d., should be given routinely for two years after all cases of ruptured intracranial aneurysm. In cases particularly at risk—for example, younger patients with a ruptured middle cerebral aneurysm associated with an intracerebral haematoma or evidence of residual brain damage—the dose should be increased to 30 mg. t.d.s. and continued for three years. If the patient has an attack, phenytoin, 100 mg. once to thrice daily, should be added. © 1965, British Medical Journal Publishing Group. All rights reserved.