Epilepsy and Intracranial Hemorrhage
By Dr. David Clark
11/22/24
Intracranial hemorrhage (ICH) or bleeding in the brain is a serious complication of hemophilia. Even with the improved treatments available today, ICH still occurs in up to 11% of hemophilia patients, and also accounts for up to 18% of deaths in those patients. ICH is also one of the major causes of epilepsy, in general. However, there have been few studies of epilepsy as a complication of hemophilia. A group from Japan looked at the characteristics of epilepsy in five pediatric patients with hemophilia (3 As; 2 Bs) at their hospital. Four patients with epilepsy had a history of ICH, while the fifth patient had had no clinical episodes but did show evidence of ICH revealed by MRI imaging studies. This represented about 10% of their total patients, which is consistent with the “up to 11%” stated above. Four patients had severe hemophilia, and all were less than two years of age.
In four patients ICH was identified before they were diagnosed with hemophilia. After diagnosis they were treated with factor concentrates or Hemlibra (for the hemophilia A patients) and had no further episodes of ICH. Epilepsy was subsequently identified in two of the patients but was not diagnosed until several years after their ICH. The rate of epilepsy was significantly higher in the patients with ICH than in the other patients with hemophilia but no ICH. Except for epilepsy, no statistically significant neurological complications were observed in the five patients with ICH, although other studies have reported developmental delays and paralysis after ICH. This suggests that epilepsy can occur without additional neurological complications.
This was a small study but it points out that epilepsy is a complication that should be recognized in patients with hemophilia. It also shows the importance of early diagnosis since treatment can potentially reduce the incidence of ICH. Finally, imaging studies are important for patients with hemophilia and epilepsy, even in those without obvious clinical episodes of ICH. [Eguchi Y et al., Cureus, 16(11) e74261, 2024]