缺血性卒中再灌注治疗后癫痫的研究进展  

Research progress on epilepsy after reperfusion therapy in ischemic stroke

作　　者：柳越 陈树达[2] 陈思卿 彭辛欣 尹思静 龙定菊 王诚蔗 郭心彤 倪冠中[1] 陈子怡[1] LIU Yue;CHEN Shuda;CHEN Siqing;PENG Xinxin;YIN Sijing;LONG Dingju;WANG Chengzhe;GUO Xintong;NI Guanzhong;CHEN Ziyi(Department of Neurology,The First Affiliated Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases,National Key Clinical Department and Key Discipline of Neurology,No.58 Zhongshan Road 2,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院神经科,广东省重大神经疾病诊治研究重点实验室,国家临床重点专科和国家重点学科,广州510080 [2]中山大学附属第七医院神经医学中心

出　　处：《中国神经精神疾病杂志》2024年第10期619-626,共8页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金(编号:82271489,81971203,81801287);广东省自然科学基金(编号:2022A1515011505,2021A1515011275,2018A030313345);广州市重点领域研发计划(编号:202206010028);深圳市科创委基础研究面上项目(编号:JCYJ20220530144609022);中国抗癫痫协会基金(编号:2019003)。

摘　　要：目前国际上尚无关于缺血性卒中患者再灌注治疗后癫痫诊断和治疗的统一指南与共识,本文从定义、机制等方面对其进行综述。缺血性卒中再灌注治疗后癫痫定义为接受了静脉溶栓和(或)机械取栓等血管内治疗的脑梗死患者,无其他明确原因或卒中前癫痫病史,脑梗死7 d后出现2次或以上痫性发作,或脑梗死30 d后出现1次或以上痫性发作。静脉溶栓后癫痫的发病率约为6.4%~20.6%,动脉机械取栓后癫痫的发病率约为5%。再灌注治疗卒中后癫痫的病理生理学机制可能与局部高灌注、溶栓药物本身致痫性及出血转化相关。较高的卒中严重程度、大脑皮质病灶、大脑中动脉供血区梗死及卒中后早发性发作可能是再灌注治疗卒中后癫痫的预测因素。左乙拉西坦及拉莫三嗪可能是缺血性卒中再灌注治疗后癫痫的有效药物,溶栓后持续痫性发作可能增加患者的死亡风险。There is no unified international guidelines or consensus on seizures and epilepsy following acute stroke reperfusion therapy so far.In this review,we briefly summarize its definitions and mechanisms.Post stroke epilepsy after reperfusion treatment is defined as patients with ischemic stroke who have received intravenous thrombolysis and/or endovascular therapy,without other definitive causes or epilepsy history before stroke,have at least two epileptic seizures occurred within 7 days of stroke onset,or at least one epileptic seizures occurred within 30 days of stroke onset.The incidence rate of epilepsy after intravenous thrombolysis is about 6.4%-20.6%,and arterial thrombectomy is about 5%.The pathophysiological mechanism of post stroke epilepsy after reperfusion treatment may be related to local hyperfusion,epileptogenic properties of tPA and hemorrhagic transformation.Higher stroke severity,cortical involvement,middle cerebral artery infarction,and early post-stroke seizures may be predictive factors for post-stroke epilepsy after reperfusion therapy.Levetiracetam and lamotrigine may be effective drugs for post-stroke epilepsy after reperfusion therapy.Sustained seizures after thrombolysis may increase the risk of death.

关 键 词：缺血性卒中 再灌注 急性症状性痫性发作 癫痫 静脉溶栓 机械取栓 

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