Imsamer Apisut, Sitthinamsuwan Bunpot, Tansirisithikul Chottiwat, Nunta-Aree Sarun
Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Department of Surgery, Vachira Phuket Hospital, Phuket, Thailand.
Neurosurg Rev. 2025 Jan 23;48(1):76. doi: 10.1007/s10143-025-03229-2.
Seizure is a relatively common neurological consequence after spontaneous intracerebral hemorrhage (SICH). This study aimed to investigate risk factors of early, late, and overall seizures in patients with SICH. Retrospective analysis was performed on all patients with SICH who completed two years of follow-up. The variables collected were obtained from demographic, clinical, radiographic and treatment data, in-hospital complications, and follow-up results. Univariate and multivariate analyzes were used to identify risk factors for post-hemorrhagic stroke seizure. Of 400 SICH patients recruited, 30 (7.5%) and 40 (10%) developed early and late seizures during the 2-year follow-up period, respectively. In the final result of the multivariate analysis, factors associated with the occurrence of the early seizure included lobar location of hematoma (p = 0.018), and GCS ≤ 12 on initial clinical presentation (p = 0.007). Factors associated with the occurrence of the late seizure included lobar location of hematoma (p = 0.001), volume of hematoma greater than 10 ml (p = 0.009), and midline shift on initial cranial CT (p = 0.036). Risk factors of the overall seizure after SICH included lobar location of hematoma (p < 0.001), volume of hematoma greater than 10 ml (p < 0.001), and craniotomy with evacuation of hematoma (p = 0.007). Furthermore, seizure was also associated with a poor functional outcome 2 years after the onset of SICH. Several factors associated with the appearance of post-ICH seizures were revealed. In patients with increased risk of post-SICH seizures, appropriate surveillance and management of seizures should be carried out.
癫痫发作是自发性脑出血（SICH）后相对常见的神经学后果。本研究旨在调查SICH患者早期、晚期及总体癫痫发作的危险因素。对所有完成两年随访的SICH患者进行回顾性分析。收集的变量来自人口统计学、临床、影像学和治疗数据、住院并发症及随访结果。采用单因素和多因素分析来确定出血性卒中后癫痫发作的危险因素。在纳入的400例SICH患者中，分别有30例（7.5%）和40例（10%）在2年随访期内发生早期和晚期癫痫发作。多因素分析的最终结果显示，与早期癫痫发作发生相关的因素包括血肿的叶性部位（p = 0.018）以及初始临床表现时格拉斯哥昏迷量表（GCS）评分≤12分（p = 0.007）。与晚期癫痫发作发生相关的因素包括血肿的叶性部位（p = 0.001）、血肿体积大于10 ml（p = 0.009）以及初始头颅CT显示的中线移位（p = 0.036）。SICH后总体癫痫发作的危险因素包括血肿的叶性部位（p < 0.001）、血肿体积大于10 ml（p < 0.001）以及开颅血肿清除术（p = 0.007）。此外，癫痫发作还与SICH发病后2年的功能预后不良相关。揭示了几个与脑出血后癫痫发作出现相关的因素。对于SICH后癫痫发作风险增加的患者，应进行适当的癫痫监测和管理。
