Abstract Details

Title Risk of Seizures after Posterior Reversible Encephalopathy Syndrome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S6 - Cerebrovascular Disease: Diagnosis, Prediction, and Population Health (4:06 PM-4:18 PM)

Poster/Presentation
Number 004

Background PRES can present with seizures in the acute phase. We hypothesized that PRES is also associated with an increased long-term seizure risk.

Objective

To determine the long-term risk of seizures after hospitalization with Posterior Reversible Encephalopathy Syndrome (PRES).

Design/Methods We performed a retrospective cohort study using statewide all-payer claims data from 2016-2018 on all admissions to nonfederal hospitals in 11 states. Adults admitted with PRES were compared to adults admitted with renal colic (negative control) and stroke (positive control). Stroke was the positive control because it is a cerebrovascular disorder known to be associated with an increased risk of seizures. The primary outcome was seizure diagnosed during an emergency room visit or hospital admission. All diagnoses were determined using ICD-10-CM codes. Patients with seizures diagnosed before and during the index admission were excluded. We used Cox regression to evaluate the association of PRES with seizure, adjusting for demographics, stroke risk factors, and additional confounders associated with PRES (cancer, kidney disease, and rheumatological disease). In a sensitivity analysis, seizure events within 2 weeks of index admission were excluded to mitigate detection bias.

Results We identified 1,277 patients hospitalized with PRES, 199,668 with stroke, and 1,802 with renal colic. Patients with PRES (55±17 years) and renal colic (53±18 years) were younger than patients with stroke (71±15 years). Median follow-up time was 0.9 years (IQR, 0.4-1.6), similar among all groups. Seizure incidence per 100 person-years was 4.9 after PRES, 1.4 after stroke, and 0.3 after renal colic. After adjustment, patients with PRES had a higher risk of seizures compared to patients with stroke (HR, 2.9; 95% CI, 2.5-3.3) and patients with renal colic (HR, 3.0; 95% CI, 2.4-3.8). Results were unchanged with a 2-week washout period.

Conclusions PRES was associated with an increased long-term seizure risk, even when compared to stroke.

Authors/Disclosures
Sarah C. Parauda, MD (Westchester Medical Center) PRESENTER	Dr. Parauda has nothing to disclose.
	No disclosure on file
Setareh Salehi Omran, MD (University of Colorado)	Dr. Salehi Omran has nothing to disclose.
	No disclosure on file
Santosh B. Murthy, MD (Weill Cornell Medicine)	Dr. Murthy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Stroke and Neurological disorders. The institution of Dr. Murthy has received research support from National Institutes of Health/NINDS.
Alexander Merkler, MD	Dr. Merkler has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Neurohospitalist. Dr. Merkler has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for n/a.
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has nothing to disclose.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
Neal S. Parikh, MD (Alnylam Pharmaceuticals)	Dr. Parikh has received personal compensation for serving as an employee of Alnylam Pharmaceuticals. Dr. Parikh has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for cases of neurological illness. Dr. Parikh has stock in Alnylam Pharmaceuticals. The institution of Dr. Parikh has received research support from Leon Levy Foundation. The institution of Dr. Parikh has received research support from Florence Gould Foundation. The institution of Dr. Parikh has received research support from NY State Empire Clinical Research Investigator Program. The institution of Dr. Parikh has received research support from NIA. The institution of Dr. Parikh has received research support from Medtronic.