卒中后癫痫发作和癫痫的临床和神经电生理研究

发布时间：2018-04-04 14:48

本文选题：卒中后癫痫复发　切入点：临床特点　出处：《青岛大学》2017年硕士论文

【摘要】：研究目的很多没有卒中知识的人经常会因为发作相似而误认为癫痫发作为卒中。癫痫发作通常是短暂的,可以在短时间内恢复正常。而卒中是一个长期且几乎总会遗留某些永久性损害的病种。当患者卒中时会通过各种形式来表现对大脑造成损伤。例如卒中能影响运动,语言,行为或记忆和情感等。还有一个卒中的影响不太明显的就是卒中后癫痫发作的几率增加。近来老年脑卒中成为癫痫发作的重要原因之一,而癫痫成为脑卒中后常见的并发症,被称为“脑卒中后癫痫”。虽然许多研究已评估过卒中后癫痫的临床风险因素和电生理特点,但对于卒中后癫痫复发的临床风险因素和电生理特点目前却没有可靠的数据。我们通过比较卒中后癫痫复发与无复发患者之间的临床、电生理及卒中后的治疗方案,来分析卒中后癫痫患者的复发相关危险因素及独立预测因素。研究方法在癫痫发作的复发研究中,收集我院2013年12月-2016年12月(中值368天)3年期间收治入我院神经内科的卒中后癫痫患者的住院病史资料及门诊随访资料。以首次癫痫发作为起始时间,通过368天的随访了解患者癫痫发作是否复发,计算癫痫发作复发率,比较单次发作组和复发组的临床特点,采用Kaplan-Meier生存曲线分析估算在90、180和360天的累积复发率。脑卒中后癫痫复发的独立预测因子是由Cox比例风险回归分析确定。结果共对104例卒中后癫痫患者(男71例,平均年龄72.1±11.2岁)进行了分析研究,其中复发的患者31例(30%)。36例(33.6%)卒中后癫痫患者一年内有癫痫发作。采用Log-rank检验分析,与卒中后癫痫发作及癫痫复发显著相关的因素包括:先前有过卒中后癫痫病史、丙戊酸钠的单药治疗、多种抗癫痫药物联合治疗、额叶皮质病变以及患者出院时改良的Rankin量表评分越高(P均0.05)。年龄小于74岁(HR 2.38,95%CI 1.02 5.90)、丙戊酸钠单药治疗(HR 3.86,95%CI 1.30 12.62)和以抽搐收治入院(HR 3.87,95%CI 1.35 12.76)是复发的独立预测因子。复发患者抽搐发作类型最主要为部分性发作且并没有继发全身性癫痫者24例(29%)。脑电图为局灶或单侧慢波表现最常见18例(30%),痫样放电主要为局灶性棘慢波7例(17.1%),局灶性癫痫持续性状态4例(4%)和1例局灶性运动型发作。结论与卒中后癫痫发作及癫痫复发显著相关的因素包括:先前有过卒中后癫痫病史、丙戊酸钠的单药治疗、多种抗癫痫药物联合治疗、额叶皮质病变以及患者出院时改良的Rankin量表评分越高(P均0.05)。PSE复发的患者的预测因素与年龄小于74岁、丙戊酸钠单药治疗和以抽搐收治入院有关。部分性发作和局灶(或单侧)慢波在复发患者中最常见。脑电图的改变能够提供动态实时的神经电生理。这些结果是在假设和前瞻性随机、双盲情况下研究,以评估卒中后癫痫的最安全和最有效的二级预防药物。
[Abstract]:Objective many people with no knowledge of stroke often mistake seizures for stroke because of similar seizures.Seizures are usually brief and can return to normal in a short period of time.Stroke is a long-term disease that almost always leaves some permanent damage.When a patient has a stroke, it can be expressed in various ways to damage the brain.Stroke, for example, can affect movement, language, behavior or memory, and emotion.Another less obvious effect of stroke is an increase in the risk of seizures after stroke.Recently, senile stroke has become one of the important causes of epilepsy, and epilepsy has become a common complication after stroke, which is called "post-stroke epilepsy".Although many studies have evaluated the clinical risk factors and electrophysiological characteristics of post-stroke epilepsy, there are no reliable data on the clinical risk factors and electrophysiological characteristics of post-stroke epilepsy recurrence.In order to analyze the risk factors and independent predictive factors of recurrent epilepsy after stroke, we compared the clinical, electrophysiological and post-stroke treatment protocols between patients with recurrent epilepsy after stroke and those without recurrence.Methods in the study of relapse of epileptic seizures, the history and follow-up data of post-stroke epilepsy patients admitted to the Department of Neurology in our hospital during the 3-year period from December 2013 to December 2016 (median 368 days) were collected.With the first seizure as the starting time, the patients were followed up for 368 days to find out whether the seizure recurred, calculate the relapse rate, and compare the clinical characteristics between the single seizure group and the recurrent group.Kaplan-Meier survival curve analysis was used to estimate the cumulative recurrence rate at 90180 and 360 days.The independent predictor of recurrent epilepsy after stroke was determined by Cox proportional risk regression analysis.Results A total of 104 patients with post-stroke epilepsy (71 males with an average age of 72.1 卤11.2 years) were studied. Among them, 31 patients with recurrent epilepsy had seizures within one year.By Log-rank test, the factors associated with post-stroke epileptic seizures and recurrent epilepsy included: previous history of post-stroke epilepsy, monotherapy of valproate sodium, and combined treatment of various antiepileptic drugs, including: previous history of epilepsy after stroke, single drug therapy of valproate sodium, and combined treatment of multiple antiepileptic drugs.The higher the cortical lesion of frontal lobe and the higher the score of modified Rankin scale at discharge, the higher the score (P < 0.05).HR2.3895 (CI 1.02 5.90), valproate alone (HR 3.86 ~ 95CI 1.30 ~ 12.62) and twitch admitted to hospital (HR 3.87 ~ 95CI 1.35 ~ 12.76) were independent predictors of recurrence.The main types of recurrent seizures were partial seizures and no secondary systemic epilepsy in 24 patients.Electroencephalogram (EEG) was the most common local or unilateral slow wave manifestation in 18 cases (30%), epileptiform discharge was mainly local spinoside slow wave (7 cases), focal epileptic persistent state (4 cases) and focal motor attack (1 case).Conclusion the factors associated with post-stroke epileptic seizures and recurrent epilepsy include previous history of post-stroke epilepsy, monotherapy of valproate sodium, and combination of various antiepileptic drugs.The higher the score of the modified Rankin scale at the time of discharge, the higher the predictive factors of the patients with recurrent 0.05).PSE were related to the age of patients less than 74 years old, valproate monotherapy and the admission of convulsions.Partial seizures and localized (or unilateral) slow waves are most common in recurrent patients.Changes in EEG can provide dynamic, real-time neurophysiology.These results were studied in a hypothetical and prospective randomized, double-blind study to assess the safest and most effective secondary prophylaxis of post-stroke epilepsy.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R742.1

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