Impact of Seizure Recurrence on 1-Year Functional Outcome and Mortality in Patients With Poststroke Epilepsy
Impact of Seizure Recurrence on 1-Year Functional Outcome and Mortality in Patients With Poststroke Epilepsy
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DOI：
10.1212/wnl.0000000000200609
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发表时间：
2022-07-26
期刊：
影响因子：
9.9
通讯作者：
Ihara, Masafumi
中科院分区：
文献类型：
--
作者：
Yoshimura, Hajime;Tanaka, Tomotaka;Ihara, Masafumi
背景和目的：卒中后癫痫（PSE）患者的功能预后和死亡率尚未在前瞻性研究中进行评估。先前的报告表明，PSE患者可能会遭受癫痫发作后长期的功能恶化。在这项研究中，我们前瞻性地调查了PSE患者的功能结局和死亡率，并分析了癫痫复发对结局的影响。方法这是卒中后癫痫预后研究的一部分，该研究是一项多中心、前瞻性观察性队列研究，在日本8家医院对392例PSE患者（最后一次症状性卒中发作后7天内至少发生1次无端癫痫发作）进行了至少1年的随访。该研究仅纳入了首次癫痫发作的PSE患者，并评估了他们1年时的功能下降和死亡率。功能下降定义为1年时改良兰金量表（mRS）评分较基线增加，不包括死亡。统计分析癫痫复发与预后的关系。结果共确定了211例患者（中位年龄为75岁;中位mRS评分为3分）。1年时，50例患者（23.7%）出现癫痫复发。关于结局，25例患者（11.8%）表现出功能下降，20例（9.5%）死亡。大多数患者死于肺炎或心脏病（各7例），没有已知的死亡原因与复发性癫痫发作直接相关。癫痫复发与功能下降显著相关（比值比[OR] 2.96，95% CI 1.25-7.03，p = 0.01），即使在调整潜在混杂因素后（调整后OR 3.26，95% CI 1.27-8.36，p = 0.01），但未发生死亡（OR 0.79，95% CI 0.25-2.48，p = 0.68）。此外，有一个显著的趋势，即复发性癫痫发作较多的患者更可能发生功能下降（无、1次和2次或2次以上复发性癫痫发作的患者分别为8.7%、20.6%和28.6%; p = 0.006）。PSE患者1年功能预后差，死亡率低。癫痫复发与功能结局显著相关，但与死亡率无关。需要进一步的研究来确定早期和充分的抗癫痫治疗是否可以防止PSE患者的功能恶化。
Background and Objectives The functional outcome and mortality of patients with poststroke epilepsy (PSE) have not been assessed in a prospective study. Previous reports have suggested that patients with PSE may suffer from prolonged functional deterioration after a seizure. In this study, we prospectively investigated the functional outcome and mortality of patients with PSE and analyzed the effect of seizure recurrence on the outcomes. Methods This is part of the Prognosis of Post-Stroke Epilepsy study, a multicenter, prospective observational cohort study, where 392 patients with PSE (at least 1 unprovoked seizure more than 7 days after the onset of the last symptomatic stroke) were followed for at least 1 year at 8 hospitals in Japan. This study included only PSE patients with a first-ever seizure and assessed their functional decline and mortality at 1 year. Functional decline was defined as an increase in modified Rankin Scale (mRS) score at 1 year compared with baseline, excluding death. The associations between the seizure recurrence and the outcomes were analyzed statistically. Results A total of 211 patients (median age of 75 years; median mRS score of 3) were identified. At 1 year, 50 patients (23.7%) experienced seizure recurrence. Regarding outcomes, 25 patients (11.8%) demonstrated functional decline and 20 (9.5%) had died. Most patients died of pneumonia or cardiac disease (7 patients each), and no known causes of death were directly related to recurrent seizures. Seizure recurrence was significantly associated with functional decline (odds ratio [OR] 2.96, 95% CI 1.25-7.03, p = 0.01), even after adjusting for potential confounders (adjusted OR 3.26, 95% CI 1.27-8.36, p = 0.01), but not with mortality (OR 0.79, 95% CI 0.25-2.48, p = 0.68). Moreover, there was a significant trend where patients with more recurrent seizures were more likely to have functional decline (8.7%, 20.6%, and 28.6% in none, 1, and 2 or more recurrent seizures, respectively; p = 0.006). Discussion One-year functional outcome and mortality of patients with PSE were poor. Seizure recurrence was significantly associated with functional outcome, but not with mortality. Further studies are needed to ascertain whether early and adequate antiseizure treatment can prevent the functional deterioration of patients with PSE.