卒中后癫痫的临床特点和抗癫痫药物治疗转归  

Clinical features and anti-epileptic drugs therapy outcomes in patients with post-stroke seizures

作　　者：吴韶蕊 毓青[1] 姚晓娟[1] 郜玉婷[1] 刘玲[1] 杨帆[1] 杨卫东[2] 陈旨娟[2] 

机构地区：[1]天津医科大学总医院神经内科,天津300052 [2]天津医科大学总医院神经外科,天津300052

出　　处：《中风与神经疾病杂志》2015年第11期1016-1020,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨不同类型脑卒中后癫痫的临床特点及抗癫痫药物(AEDs)治疗转归及痫性发作的再发诱因,旨在指导脑卒中后癫痫的临床防治。方法收集我院神经内科及癫痫专科门诊就诊的卒中后癫痫患者77例并随访观察,根据入组患者卒中后首次痫性发作的时间分组,分为早发性癫痫组(脑卒中后≤2 w发作者)32例和晚发性癫痫组(脑卒中后>2 w发作者)45例。分析两组患者卒中部位、痫性发作类型、脑电图特点、抗癫痫药治疗及痫性发作的再发诱因。结果 (1)卒中后癫痫相关的常见脑部病变部位依次为皮质、皮质下、丘脑等。(2)早发性癫痫以部分性发作为主,占53.1%;晚发性癫痫以全面强直阵挛发作(包括可能的部分继发全面性发作)为主,占71.1%。(3)早发性癫痫组与晚发性癫痫组比较,长程视频脑电图(VEEG)和常规脑电图(REEG)异常波检出率和痫样放电波检出率的差异无统计学意义(P>0.05);两种脑电图痫样放电波检出率的比较,VEEG的检出率高于REEG(χ2=8.376,P<0.05),异常波检出率的比较差异无统计学意义(P>0.05)。(4)早发性癫痫组经AEDs治疗后发作控制的无发作率及有效率均高于晚发性癫痫组(P<0.05)。(5)再次发作有诱因者占65.5%(主要为发热、服药不规律、不良生活习惯、情绪因素),无诱因者占34.5%。结论皮质、皮质下卒中及发作间期脑电图有痫样放电的患者应警惕痫性发作及反复发作,首次发作后再次发作的患者,应考虑规律服用抗癫痫药物治疗,并尽量避免再发诱因。Objective To investigate the clinical features of post-stroke seizures and anti-epileptic drugs（ AEDs）therapy outcomes and relapse factors,guide prevention and treatment of epilepsy after stroke. Methods A total of 77 patients with post-stroke seizures diagnosed in neurology and epilepsy specialist clinic of our hospital from September 2014 to May 2015 were recruited. According to the first on-set time of seizures after stroke,they were divided into an early-onset epilepsy group（ 32 patients with epileptic occurring within 2 weeks） and late-onset epilepsy group（ 42 patients with epileptic occurring after 2 weeks）. The location of lesion,the type of seizures,abnormality of electroencephalograph（ EEG）,AEDs therapy and relapse factors were compared. Results（ 1） The location of lesion related to post-stroke seizures were cortical、sub-cortical、thalamus and so on.（ 2） The patients in the early-onset epilepsy group were mainly partial seizures,accounting for 53. 1%; The patients in the late-onset epilepsy group were mainly generalized tonic-clonic seizures,accounting for 71. 1%.（ 3） Between the early-onset epilepsy and late-onset epilepsy groups,there were no significant differences in the rate of abnormal results and epileptiform discharges of video EEG（ VEEG） and routine EEG（ REEG）.The rate of epileptiform discharge monitoring by VEEG was higher than that by REEG（ χ2= 8. 376,P〈0. 05）,while there was no significant difference in the rate of abnormal result.（ 4） The rate of seizure-free and efficiency in early-onset epilepsy group was higher than late-onset epilepsy group（ P〈0. 05）.（ 5） As for recurrent seizures,there were no obvious precipitating factors for 34. 5% patients,65. 5% were connected with precipitating factors,mainly including favor,irregular medication,unhealthy living habits,mood. Conclusion Cortex,sub-cortical stroke patients and patients whose EEG shows epileptiform discharges should be alert to seizures and recurrent seizures. Seizures recurr

关 键 词：脑卒中 癫痫 脑电图 抗癫痫药物 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R742.1[医药卫生—临床医学]