摘要
目的：探讨卒中后痫性发作与癫痫的临床特点。方法对2003年7月至2008年6月972例连续卒中病例中74例卒中后痫性发作与癫痫患者的临床资料进行回顾性分析。结果卒中后痫性发作发病率为7．6％。缺血性卒中患者出现痫性发作47例（6．8％），其中皮层梗死24例（51．1％），大面积梗死9例（19．1％），皮层下梗死14例（29．8％）；颅内出血患者出现痫性发作24例（8．8％），其中皮层出血16例（66．7％），皮层下出血8例（33．3％）；蛛网膜下腔出血组3例（30％）。早期痫性发作58例（78．4％），晚期痫性发作16例（21．6％）。42例进行常规脑电图检查，结果：24例未见异常，14例痫样放电，4例阵发性广泛中-高幅慢活动。早期痫性发作患者4例一周内死亡。卒中后癫痫患者中10例和3例分别服药1年和2年后停药无复发；4例持续用药，平均治疗时间2．5年；4例死亡，2例失访。结论卒中病灶部位、范围及卒中类型是卒中后痫性发作的预测因素。晚期痫性发作是卒中后癫痫的危险因素。卒中后痫性发作的诊断主要依靠病史。一些新型抗癫痫药物可作为单药治疗卒中后痫性发作和癫痫的一线选择。
Abstract
Objective To study the clinical features of poststroke seizures and epilepsy .Methods Medical documents of 74 patients with poststroke seizures and epi-lepsy,accounting for 7.6% of 972 consecutive stroke patients from 2003 July to 2008 June,were retrospectively analyzed.Results Seizures were developed in 47 patients with ischemic stroke(6.8%),and in 24 patients with intracerebral hemorrhage(8.8%),and in 3 patients with subarachnoid hemorrhage(30.0%).There were 58 pa-tients with early seizures and 16 patients with late seizures,respectively.Among 47 patients with seizures after ischemic stroke,24 patients suffered from cortical infarct, 14 from subcortical infarct,and 9 from massive infarct.Among 24 patients with seizures after intracerebral hemorrhage ,16 patients suffered from cortical hemorrhage and 8 from subcortical hemorrhage.Routine electroencephalography was performed in 42 patients with seizures,epileptiform discharge was seen in 14 patients,paroxysmal dif-fused slow activity in 4 and the rest 24 patients did not show apparent abnormality.Four patients with early seizures died within 7 days.Ten and 3 patients with poststroke epilepsy got free from seizures after 1 and 2 years of medical treatment,respectively;4 patients keep on medical treatment for an average time of 2.5 years;4 died and 2 lost during follow-up.Conclusion Cortical lesions,massive infarcts and hemorrhagic stroke may be predictors for poststroke seizures .Late poststroke seizure may be a risk factor for poststroke epilepsy.The diagnosis of poststroke seizures was mainly based on an accurate description of manifestation and some new anti -epileptic drugs can be the first-line monotherapy in patients with poststroke seizures and epilepsy .
基金项目
科研项目广东省佛山市卫生局医学科研课题(2011498)
NETL
NSTL
万方数据