Seizures and Epilepsy after Ischemic Stroke.
Seizures and Epilepsy after Ischemic Stroke.
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DOI：
10.1046/j.1535-7597.2003.03408.x
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发表时间：
2003-07-01
影响因子：
3.6
通讯作者：
Berg, Anne T.
中科院分区：
文献类型：
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作者：
Berg, Anne T.
目的：探讨青壮年缺血性卒中后早期和晚期癫痫的发生率及预测因素。方法：前瞻性研究30个神经内科收治的581例近期不明原因缺血性卒中患者，年龄18~55岁，随访37.8±9.7个月。通过回顾图表评估早期癫痫发作(发生在中风后7天内)，并在每次随访时前瞻性地记录晚期癫痫发作。结果：581例患者中有14例(2.4%)出现早期癫痫，其中71%发生在24小时内。Rankin评分=3(优势比[OR]3.9，95%可信区间1.2~12.7)和皮质受累(OR 7.7，95%可信区间1.0~61.1)与早期癫痫发作独立相关。迟发性癫痫发作仅发生在大脑半球卒中患者(n=20)。1年内首次迟发性癫痫发作的风险为3.1%(95%CI 1.4~4.8)，3年内首次迟发性癫痫发作的危险性为5.5%(95%CI 3.1~7.9)。卒中至首次迟发性癫痫发作的平均延迟时间为12.9个月(0.3~33.9)。晚期癫痫发作与早期癫痫发作(危险比[HR]5.1，95%可信区间1.8~14.8)、皮质体征(HR 4.5，95%可信区间1.6~13.1)和大脑半球以上梗塞面积(HR 9.7，95%可信区间3.1~30.8)有关。在20例晚期癫痫患者中，有11例在接受抗癫痫药物治疗后复发(8例中有多例)。他们中的大多数在随访结束时癫痫发作消失。结论：癫痫很少是年轻的不明原因缺血性卒中幸存者的主要问题。早期癫痫发作与中风、残疾和皮质受累有关。早期癫痫发作、皮质体征和大面积脑梗塞是晚期癫痫发作的独立危险因素。
OBJECTIVES: To assess the incidence and predictive factors of early and late seizures after ischemic stroke in young adults.METHODS: A total of 581 patients (aged 18 to 55 years) with recent cryptogenic ischemic stroke were prospectively enrolled at 30 neurology departments and followed for 37.8±9.7 months. Early seizures (occurring within 7 days of stroke) were assessed by chart review and late seizures were prospectively recorded at each follow-up visit. Clinical and brain imaging findings were reviewed by two neurologists and two neuroradiologists who were blinded to the occurrence of seizures.RESULTS: Fourteen of the 581 patients (2.4%) developed early seizures, 71% of which occurred within the first 24 hours. Rankin scale>= 3 (odds ratio [OR] 3.9, 95% CI 1.2 to 12.7) and cortical involvement (OR 7.7, 95% CI 1.0 to 61.1) were independently associated with early seizures. Late seizures occurred only in patients with hemispheric stroke (n= 20). The risk of first late seizure was 3.1%(95% CI 1.4 to 4.8) within 1 year and 5.5%(95% CI 3.1 to 7.9) within 3 years. The mean delay between stroke and first late seizure was 12.9 months (0.3 to 33.9). Late seizures were associated with early seizure (hazard ratio [HR] 5.1, 95% CI 1.8 to 14.8), cortical signs (HR 4.5, 95% CI 1.6 to 13.1), and size of infarct superior to one-half hemisphere (HR 9.7, 95% CI 3.1 to 30.8). Eleven of the 20 patients with late seizure experienced recurrences (multiple in eight) on antiepileptic drug treatment. Most of them were seizure free at the end of the follow-up.CONCLUSION: Epilepsy is rarely a major problem in young cryptogenic ischemic stroke survivors. Early seizures are associated with stroke disability and cortical involvement. Early seizures, cortical signs, and large infarct are independent risk factors for late seizures.