Predictors and clinical impact of epilepsy after subarachnoid hemorrhage
Predictors and clinical impact of epilepsy after subarachnoid hemorrhage
复制标题
DOI：
10.1212/01.wnl.0000038906.71394.de
复制
发表时间：
2003-01-28
期刊：
影响因子：
9.9
通讯作者：
Mayer, SA
中科院分区：
文献类型：
--
作者：
Claassen, J;Peery, S;Mayer, SA
目的：确定蛛网膜下腔出血（SAH）后第一年内癫痫发生的频率、预测因素及其对预后的影响。方法：作者前瞻性分析了431例接受5年以上治疗的SAH患者中的247例，这些患者在12个月随访时仍然存活。癫痫定义为出院后两次或两次以上的无端癫痫发作。结果：新发癫痫发生在7%（n = 17）的患者，另外4%（n = 10）只有一个癫痫发作后出院。癫痫的独立预测因素包括硬膜下血肿（OR 9.9，95% CI 1.9 - 52.8）和脑梗死（OR 3.9，95% CI 1.4 - 11.3）。与未发生癫痫的患者不同，发生癫痫的患者在SAH后3至12个月内未能经历改良兰金量表（mRS）的功能恢复。12个月时，癫痫与严重残疾独立相关mRS（评分大于或等于3）（OR 10.3，95% CI 2.5 - 42.0），增加，Lawton工具性日常生活活动量表上的工具性残疾（OR 4.9; 95% CI 1.1 - 22.2），疾病影响特征中的生活质量降低（OR 4.5; 95% CI 1.1 - 18.0），Spielberger焦虑量表上的状态焦虑增加（OR 4.8; 95% CI 1.1 - 20.4）。癫痫与认知障碍、抑郁或主观生活满意度无关。结论：癫痫发生在7%的SAH患者中，可通过硬膜下血肿和脑梗死预测，并与功能恢复和生活质量差相关。我们的研究结果表明，局灶性病理，而不是弥漫性损伤出血，是癫痫后SAH的主要原因。
Objective: To determine the frequency, predictors, and impact on outcome of epilepsy developing during the first year after subarachnoid hemorrhage (SAH). Methods: The authors prospectively analyzed 247 of 431 patients with SAH treated over a period of 5 years who were alive with follow-up at 12 months. Epilepsy was defined as two or more unprovoked seizures after hospital discharge. Results: New-onset epilepsy occurred in 7% (n = 17) of patients; an additional 4% (n = 10) had only one seizure after discharge. Independent predictors of epilepsy included subdural hematoma (OR 9.9, 95% CI 1.9 to 52.8) and cerebral infarction (OR 3.9, 95% CI 1.4 to 11.3). Unlike those without seizures, patients who developed epilepsy failed to experience functional recovery on the modified Rankin Scale (mRS) between 3 and 12 months after SAH. At 12 months epilepsy was independently associated with severe disability (score greater than or equal to 3) on the mRS (OR 10.3, 95% CI 2.5 to 42.0), increased, instrumental disability on the Lawton Instrumental Activities of Daily Living scale (OR 4.9; 95% CI 1.1 to 22.2), reduced quality of life on the Sickness Impact Profile (OR 4.5; 95% CI 1.1 to 18.0), and increased state anxiety on the Spielberger Anxiety Inventory (OR 4.8; 95% CI 1.1 to 20.4). Epilepsy was not associated with cognitive impairment, depression, or subjective life satisfaction. Conclusion: Epilepsy occurred in 7% of patients with SAH, was predicted by subdural hematoma and cerebral infarction, and was associated with poor functional recovery and quality of life. Our findings indicate that focal pathology, rather than diffuse injury from hemorrhage, is the principal cause of epilepsy after SAH.