不同时机抗癫痫药物治疗脑卒中后癫痫发作的效果及预后  

Efficacy and prognostic implications of antiepileptic drugs at different time intervals for the management of post-stroke epilepsy

作　　者：季思媛 李开军[2] 冯亚南 叶丽 华奇峰 JI Siyuan;LI Kaijun;FENG Yanan(Zhejiang Chinese Medical University,Hangzhou 310000,China)

机构地区：[1]浙江中医药大学,浙江杭州310000 [2]丽水市中心医院全科医学科 [3]丽水市中心医院神经内科

出　　处：《全科医学临床与教育》2024年第11期997-1000,共4页Clinical Education of General Practice

摘　　要：目的探讨脑卒中后癫痫发作的抗癫痫药物(AEDs)最佳治疗时机以指导临床用药。方法选取脑卒中后癫痫发作患者共110例,且发作后随访时间≥12个月,根据癫痫发生时间的不同,将研究对象分为ES组(脑卒中后2周内)41例和LS组(脑卒中后2周以上)69例,再根据首次癫痫发作后是否给予AEDs治疗分为ES治疗组、ES未治疗组,LS治疗组、LS未治疗组,对比各组在不同随访时间点再发癫痫的情况。结果ES组中,再次发生癫痫的患者共15例,占36.59%,LS组中,再次发生癫痫的患者共53例,占76.81%。LS组癫痫再发率明显高于ES组,差异均有统计学意义(χ^(2)=17.63,P<0.05)。ES组在随访3个月内、6个月内、9个月内、12个月内的癫痫再发率均明显低于LS组,差异均有统计学意义(χ^(2)分别=4.13、4.52、5.37、8.50,P均<0.05)。LS未治疗组在4个时间节点的癫痫再发率均明显高于LS治疗组,差异均有统计学意义(χ^(2)分别=7.37、4.54、4.47、6.10,P均<0.05);LS未治疗组在9个月内及12个月内癫痫再发率明显高于ES未治疗组,差异均有统计学意义(χ^(2)分别=6.08、9.42,P均<0.05)。3个月内、6个月内、9个月内、12个月内,ES治疗组与ES未治疗组的癫痫再发率比较,差异均无统计学意义(χ^(2)分别=0.03、0.02、0.01、0.01,P均>0.05);LS治疗组与ES未治疗组的癫痫再发率比较,差异均无统计学意义(χ^(2)分别=0.15、0.41、0.87、1.51,P均>0.05)。结论脑卒中后2周后癫痫发作的患者发病后可考虑长期应用AEDs治疗,而脑卒中后2周内癫痫发作的患者不建议给予长期AEDs治疗,若给予治疗半年后未出现再发可考虑减停AEDs药物。Objective To investigate the best timing of antiepileptic drugs(AEDs)in post-stroke seizures to guide clinical medication.Methods A total of 110 patients with post-stroke seizures were enrolled and the follow-up time was≥12 months.According to the different onset times of epilepsy,the study subjects were divided into an ES group(≤2 weeks after stroke)of 41 cases and an LS group(>2 weeks after stroke)of 69 cases.According to whether AED treatment was given after the first epileptic seizure,the patients were divided into ES treatment group,ES untreated group,LS treatment group,and LS untreated group.The recurrence of epilepsy at different follow-up time points was com⁃pared among the groups.Results In the ES group,there were a total of 15 patients who experienced recurrent epilepsy,accounting for 36.59%.In the LS group,there were 53 patients who experienced recurrent epilepsy,accounting for 76.81%.The recurrence rate of LS group was significantly higher than that of the ES group,and the difference was statis⁃tically significant(χ^(2)=17.63,P<0.05).The recurrence rates of epilepsy in the ES group were significantly lower than those in the LS group within 3 months,6 months,9 months,and 12 months of follow-up,and the differences were statisti⁃cally significant(χ^(2)=4.13,4.52,5.37,8.50,P<0.05).The recurrence rate of epilepsy in the untreat⁃ed group of LS was significantly higher than that in the treated group at all four time points(χ^(2)=7.37,4.54,4.47,6.10,P<0.05).The recurrence rate of epilepsy in the LS untreated group within 9 months and 12 months was significantly higher than that in the ES untreated group,and the difference was statistically significant(χ^(2)=6.08,9.42,P<0.05).There was no significant difference in the probability of recurrent epilepsy between the ES treatment group and the ES untreated group(χ^(2)=0.03,0.02,0.01,0.01,P>0.05).There was no significant difference in the probability of recurrent epilepsy between the LS treatment group and the ES untreated group(χ^(2)=0.15,0.41,0.

关 键 词：脑卒中后癫痫 抗癫痫药物 不同治疗时机 临床观察 

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