ปัจจัยที่สัมพันธ์กับอาการชักหลังโรคหลอดเลือดสมองตีบ: กรณีศึกษาโรงพยาบาลยโสธร: Factors Associated with Post-Stroke Seizures in Patients with Ischemic Stroke: A Case Study at Yasothon Hospital

อัจฉริยาพร  นวลเพ็ญ

Authors

อัจฉริยาพร นวลเพ็ญ Yasothon Hospital

Keywords:

ปัจจัยเสี่ยง, โรคหลอดเลือดสมองตีบ, อาการชักหลังโรคหลอดเลือดสมอง, Early-onset Seizure, Late-onset Seizure, Ischemic stroke, Post-stroke seizure, Risk factors

Abstract

Background: Seizures are a significant complication following ischemic stroke, impacting clinical outcomes and patients' quality of life. Identifying associated factors is crucial for screening high-risk patients and providing appropriate care.

Objective: This study aimed to investigate the clinical factors, neuroimaging characteristics, and clinical outcomes associated with post-stroke seizures at Yasothon Hospital.

Methods: This retrospective descriptive study was conducted on ischemic stroke patients with seizures at Yasothon Hospital between January 1, 2023, and December 31, 2025. Data were collected from medical records, including demographics, stroke severity (NIHSS score), neuroimaging findings, seizure onset, and clinical outcomes (mRS). Statistical analysis utilized descriptive statistics, independent t-tests, and chi-square tests to compare early-onset and late-onset seizures. Bonferroni correction was applied for multiple comparisons, with statistical significance set at p < 0.05.

Results: A total of 80 patients were included (mean age 66.01 ± 11.97 years, 71.2% male). Early-onset seizures (≤7 days) occurred in 35.0% and late-onset seizures (>7 days) in 65.0% of cases. The most prevalent seizure type was generalized tonic-clonic seizure (71.2%). Common comorbidities included hypertension (83.8%) and diabetes mellitus (47.5%). According to the TOAST classification, large-artery atherosclerosis was the predominant etiology (61.2%). Regarding stroke severity, the early-onset seizure group had a significantly higher mean admission NIHSS score compared to the late-onset group (11.9 ± 6.8 vs. 8.3 ± 7.1; p = 0.019). Approximately two-thirds of patients in the early-onset group presented with severe stroke (NIHSS ≥ 11), a proportion significantly higher than that in the late-onset group (64.3% vs. 34.6%; p = 0.015). However, these differences were not statistically significant after Bonferroni correction (Adjusted p = 0.360 and 0.285, respectively). Notably, the early-onset seizure group had a significantly longer hospital stay (8.1 ± 7.1 vs. 5.9 ± 7.0 days; p = 0.001). Overall, poor clinical outcomes (mRS 3–6) were observed in 58.8% of patients, with a mortality rate of 8.8%. Factors significantly associated with poor outcomes, even after Bonferroni correction, were admission NIHSS score (Adjusted p < 0.009) and the presence of cortical involvement (Adjusted p = 0.010).

Conclusion: Stroke severity and length of hospital stay are significantly associated with early-onset seizures. Furthermore, admission NIHSS scores and cortical involvement serve as critical predictors for poor functional outcomes. Patients with severe stroke severity and cortical involvement should be closely monitored for seizures and receive intensive care in both acute and long-term phases.

Keywords: Ischemic stroke, Post-stroke seizure, Risk factors, Early-onset seizure, Late-onset seizure

References

Feigin VL, Brainin M, Norrving B, Martins SO, Pandian J, Lindsay P, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke 2025; 20(2): 132-44. doi: 10.1177/17474930241308142. PubMed PMID: 39635884.

Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. Heart disease and stroke statistics–2023 update: a report from the American Heart Association. Circulation 2023; 147(8): e93-621. doi: 10.1161/CIR.0000000000001123. PubMed PMID: 36695182.

กรมควบคุมโรค กระทรวงสาธารณสุข. รายงานการเฝ้าระวังโรคไม่ติดต่อเรื้อรัง ประจำปี พ.ศ. 2566. นนทบุรี: กรมควบคุมโรค; 2567.

ชลธิชา อัจฉรียกุล, รัชนี ปิยะมิตต์, สมเกียรติ ภู่วรวรรณ. การคาดการณ์ภาระโรคหลอดเลือดสมองในประเทศไทย พ.ศ. 2563-2580. วารสารระบาดวิทยา 2565; 47(2): 123-35.

Misra S, Kasner SE, Dawson J, Tanaka T, Zhao Y, Zaveri HP, et al. Outcomes in patients with poststroke seizures: a systematic review and meta-analysis. JAMA Neurol 2023; 80(11): 1155-65. doi: 10.1001/jamaneurol.2023.3240. PubMed PMID: 37721736.

Beghi E, D'Alessandro R, Beretta S, Consoli D, Crespi V, Delaj L, et al. Incidence and predictors of acute symptomatic seizures after stroke. Neurology 2011; 77(20): 1785–93. doi: 10.1212/WNL.0b013e3182364878. PubMed PMID: 21975208.

Tanaka T, Ihara M, Fukuma K, Mishra NK, Koepp MJ, Guekht A, et al. Pathophysiology, diagnosis, prognosis, and prevention of poststroke epilepsy: clinical and research implications. Neurology 2024; 102(11): e209450. doi: 10.1212/WNL.0000000000209450. PubMed PMID: 38759128.

Zhang C, Wang X, Wang Y, Zhang JG, Hu W, Ge M, et al. Risk factors for post-stroke seizures: a systematic review and meta-analysis. Epilepsy Res 2014; 108(10): 1806-16. doi: 10.1016/j.eplepsyres.2014.09.030. PubMed PMID: 25454500.

กิตติ ศรีสุข, ณัฐพล เจริญสุข, อรรถพล มั่นคง. อุบัติการณ์และปัจจัยเสี่ยงของอาการชักหลังโรคหลอดเลือดสมองตีบในผู้ป่วยไทย: การศึกษาพหุศูนย์. วารสารประสาทวิทยาแห่งประเทศไทย 2564; 36(3): 187-98.

สำนักงานสถิติแห่งชาติ. การสำรวจประชากรสูงอายุในประเทศไทย พ.ศ. 2566. กรุงเทพฯ: สำนักงานสถิติแห่งชาติ; 2566.

Xu M, Wang Y, Wang C, Li X. Post-stroke seizure: epidemiology, pathophysiology, and clinical management. Neurol Sci 2021; 42(5): 1701-10.

Ferlazzo E, Gasparini S, Beghi E, Sueri C, Russo E, Leo A, et al. Epilepsy in cerebrovascular diseases: review of experimental and clinical data with meta-analysis of risk factors. Epilepsia 2016; 57(8): 1205-14. doi: 10.1111/epi.13448. PubMed PMID: 27381481.

Brigo F, Schneider M, Wagenpfeil G, Becker SL, Nardone R, Lattanzi S. Cortical involvement and post-stroke seizures: a systematic review and meta-analysis. J Neurol 2021; 268(8): 2713-22.

Lv J, Wang W, Li Y. Mechanisms of post-stroke seizures: from ionic imbalance to network reorganization. Front Neurol 2021; 12: 765129.

Serafini A, Gigli GL, Gregoraci G, Janes F, Cancelli I, Novello S, et al. Are early seizures predictive of epilepsy after a stroke? Results of a population-based study. Neuroepidemiology 2015; 45(1): 50-8. doi: 10.1159/000382078. PubMed PMID: 26227564.

Kim YH, Park JM, Choi KH, Park MS, Kim BK, Kim JT, et al. Factors associated with early seizures after acute ischemic stroke: a hospital-based study. Eur Neurol 2020; 83(1): 38-44.

Battino D, Rossi L, Bonanni P. Cortical involvement as predictor of late-onset post-stroke epilepsy. Epilepsia Open 2022; 7(2): 308-16.

Messé SR, Tadi P, Cucchiara BL, Luciano JM, Kasner SE. Outcomes of patients with seizures after stroke. Cerebrovasc Dis 2021; 50(5): 519-26.

Galovic M, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Conrad J, et al. Prediction of late seizures after ischaemic stroke with a novel prognostic model (the SeLECT score): a multivariable prediction model development and validation study. Lancet Neurol 2018; 17(2): 143-52. doi: 10.1016/S1474-4422(17)30404-0. PubMed PMID: 29413315.

Myint PK, Staufenberg EF, Sabanathan K. Post-stroke seizure and post-stroke epilepsy. Postgrad Med J 2006; 82(971): 568-72. doi: 10.1136/pgmj.2005.041426. PubMed PMID: 16954451.

Graham NS, Crichton S, Koutroumanidis M, Wolfe CD, Rudd AG. Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register. Stroke 2013; 44(3): 605-11. doi: 10.1161/STROKEAHA.111.000220. PubMed PMID: 23370202.