Predictors and outcome of seizures after spontaneous intracerebral hemorrhage

Clinical article

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Seizures are an important neurological complication of spontaneous intracerebral hemorrhage (ICH). A better understanding of the risk factors of seizures following ICH is needed to predict which patients will require treatment.


Two hundred and forty-three adult patients were enrolled in this 1-year retrospective study. Multiple logistic regression was used to evaluate the relationship between baseline clinical factors and the presence or absence of seizure during the study period.


Seizures occurred in 20 patients with ICH, including acute symptomatic seizures in 9 and unprovoked seizures in 11. None progressed to status epilepticus during hospitalization. After a minimum 3-year follow-up period, the mean Glasgow Outcome Scale score was 3.8 ± 1.1 for patients who had had seizures and 3.5 ± 1.3 for those who had not. The multiple logistic regression model demonstrated that the mean ICH volume was independently associated with seizures, and any increase of 1 mm3 in ICH volume increased the seizure rate by 2.7%.


Higher mean ICH volumes at presentation were predictive of seizure, and the presence of late seizures was predictive of developing epilepsy. Most seizures occurred within 2 years of spontaneous ICH over a minimum of 3 years of follow-up.

Abbreviations used in this paper: AED = antiepileptic drug; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICH = intracerebral hemorrhage; ROI = region of interest.

Article Information

Address correspondence to: Cheng-Hsien Lu, M.D., Department of Neurology, Chang Gung, Memorial Hospital 123, Ta Pei Road, Niao Sung Hsiang Kaohsiung Hsien, Taiwan. email:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Representative admission CT scans (A and B) and 3D CT image (C) showing a hematoma. The ROIs were drawn on each slice to include the hematoma, absolute hematoma volumes were calculated with a semiautomated process.

  • View in gallery

    Bar graph showing when the first seizure occurred after spontaneous ICH in the follow-up period.


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