卒中后癫痫发作长期AEDs治疗时机及卒中后癫痫患者AEDs治疗转归

发布时间：2018-05-29 10:07

本文选题：卒中后癫痫 + 早发性癫痫发作　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的探讨卒中后癫痫发作的长期抗癫痫药物(AEDs)治疗时机,进一步研究卒中后癫痫(Post-Stroke Epilepsy,PSE)患者AEDs治疗转归进而指导临床。方法:研究一:纳入2014年9月-2016年8月天津医科大学总医院神经内科住院及门诊就诊的至少有一次卒中后癫痫发作,且发作后随访时间≥12m,长期服用或未服用AEDs治疗的患者,根据卒中后首次癫痫发作的时间分为2组:(1)早发性癫痫发作(Early-onset seizure,ES)组(卒中后≤2周);(2)晚发性癫痫发作(Late-onset seizure,LS)组(卒中后2周)。通过癫痫门诊随诊及电话随访方式收集癫痫患者的基本资料(年龄、性别、急性卒中时间、卒中类型等)及癫痫相关资料(首次癫痫发作的时间、距卒中发生的时间、癫痫发作类型、发作后病程、首次癫痫发作后是否给予长期的正规AEDs治疗、治疗药物、剂量、患者服药依从性等)并建立电子病历管理系统。再根据首次癫痫发作后是否给予AED治疗分为ES治疗组、未治疗组,LS治疗组、未治疗组。对比分析各组及亚组在不同随访时间点发生第二次癫痫发作的再发率及好发时间。研究二:纳入2014年9月-2017年3月天津医科大学总医院神经内科住院及门诊就诊至少两次卒中后癫痫发作及符合卒中后癫痫定义并长期服用AEDs的患者。无发作为随访期内≥12m未出现癫痫发作;有效为其发作较基线水平(3个最长发作间歇期或1年内的发作总数)减少≥50%以上,尚不能达到无发作;总有效率包括无发作率及有效率。通过天津医科大学总医院癫痫专科门诊复诊及电话随访方式,记录PSE患者的年龄、性别、随访时间、卒中类型、癫痫发作形式及次数、脑电图异常分布、长期服用AEDs种类等情况。通过随访期内经AEDs治疗的无发作率、有效率、总有效率及无发作患者AEDs的治疗情况,研究AEDs的治疗转归。应用SPSS21.0软件进行统计分析,p0.05差异有统计学意义。结果研究一:根据纳入及排除标准,纳入患者90例,ES组31例,其中ES治疗组19例,未治疗组12例;LS组59例,其中LS治疗组36例,未治疗组23例。随访时间12-96个月(中位数20个月),1年内不同随访时间点(3m、6m、9m、12m)发生第二次癫痫发作的再发率在各组及亚组之间的比较:(1)LS组高于ES组(49.15%?69.49%vs.25.81%?38.71%),差异有统计学意义(p0.05);(2)LS未治疗组高于ES未治疗组(56.52%?73.91%vs.16.77%?33.33%)且在3m、12m时间点差异有统计学意义(p0.05);(3)ES治疗组与未治疗组、LS治疗组与未治疗组、ES治疗组与LS治疗组比较,差异无统计学意义(p0.05)。整个随访期内ES组及LS组癫痫再发者在不同时间的发生率3个月最高,3?6个月次之,6个月内分别高达91.67%、76.59%。研究二:根据纳入及排除标准,纳入PSE患者79例;随访时间12-100个月(中位数23个月);癫痫发作次数0.36~15次/年(中位数2次/年)。所有患者服用1~3种AEDs治疗:(1)单药+联合治疗:无发作率为40.51%(32/79),治疗有效率为48.10%(38/79),总有效率为88.61%(70/79);(2)单药治疗:无发作率为27.85%(22/79),治疗有效率27.85%(22/79),总有效率为55.70%(44/79);(3)联合治疗:无发作率为33.33%(10/30),治疗有效率为53.33%(16/30),总有效率为86.67%(26/30);(4)整个随访期内服用丙戊酸类的患者40例,左乙拉西坦的患者44例。以丙戊酸类为例:1)单药治疗:无发作率为25%(10/40),有效率为17.5%(7/40),总有效率为42.5%(17/40);2)丙戊酸类+其他AEDs:无发作率为28.57%(6/21),有效率为57.14%(12/21),总有效率为85.71%(18/21)。以左乙拉西坦为例:1)单药治疗:无发作率为27.27%(12/44),有效率为25%(11/44),总有效率为52.27%(23/44);2)左乙拉西坦+其他AEDs:无发作率为42.86%(9/21),有效率为42.86%(9/21),总有效率为85.71%(18/21)。(5)无发作患者的无发作时间主要集中在1~2年(81.25%);(6)在无发作患者中,单药治疗22/32例(68.75%),2种AEDs联合治疗10/32例(31.25%),其中丙戊酸单药治疗10/32例(32.25%),其无发作的治疗剂量为500-1000mg/d 9/10例(90%),联合治疗6/32例(18.75%),其无发作的治疗剂量为500-1000mg/d 5/6例(83.33%);左乙拉西坦单药治疗12/32例(37.50%),其无发作的治疗剂量为500-1000mg/d 11/12例(91.67%),联合治疗9/32例(28.13%),其无发作的治疗剂量为500-1000mg/d 7/9例(77.78%)。结论1.仅一次卒中后早发性癫痫发作可暂缓AEDs治疗,再发后建议长期AEDs治疗;而晚发性癫痫发作较早发性的再发率高,建议首次发作后开始长期AEDs治疗。2.卒中后癫痫患者的脑电图表现一般不累及背景异常,主要表现为慢波伴癫痫波,慢波反应一定程度的脑部损害。经AEDs治疗PSE患者的每年的发作频率较低(2次/年),1~2种AEDs便可得到较好的控制,并得到长时间的无发作且AEDs的用药剂量较小。
[Abstract]:Objective to explore the timing of long-term antiepileptic drug (AEDs) treatment for epileptic seizures after stroke and to further study the outcome of AEDs treatment for patients with post stroke Post-Stroke Epilepsy (PSE) and then guide the clinic. Epileptic seizures after stroke, and follow-up time of more than 12M, patients who had long or not taken AEDs for the first time were divided into 2 groups according to the first seizure after stroke: (1) premature seizures (Early-onset seizure, ES) group (after stroke less than 2 weeks); (2) late onset seizures (Late-onset seizure, LS) group (2 weeks after stroke). Epilepsy (2 weeks after stroke). The basic information of epileptic patients (age, sex, acute stroke time, stroke type, etc.) and epilepsy related data (the time of the first seizure, the time of the onset of the stroke, the type of epileptic seizure, the course of the onset of the seizure, and the long-term regular AEDs treatment after the first epileptic seizure, and the treatment of the drug, " Dose, patient compliance, etc.) and establish an electronic medical record management system. Then according to the first epileptic seizures, AED treatment was given to the ES treatment group, the untreated group, the LS treatment group, and the untreated group. The recurrence rate and time of second epileptic seizures in each group and the subgroup were compared and analyzed at different time points. Study two: 2014 In September -2017, -2017 March, the General Hospital Affiliated to Tianjin Medical University neurology department of Neurology hospitalized at least two stroke epileptic seizures and patients with post-stroke epilepsy definition and long-term use of AEDs. No onset of epilepsy during the follow-up period was no more than 12m. It was effective for its attack compared with baseline (3 longest episodes or 1 years of onset. The total number was less than 50% or more, and the total effective rate was no seizure. The total effective rate included no attack rate and efficiency. The age, sex, follow-up time, type of stroke, the form and frequency of epileptic seizures, abnormal distribution of EEG, and long-term use of AED were recorded in the clinic of the General Hospital Affiliated to Tianjin Medical University in the epilepsy specialist clinic and telephone follow-up. S type and other conditions. Through the follow-up period of AEDs treatment without attack rate, efficiency, total efficiency and non attack patients with AEDs treatment, study the treatment of AEDs, the application of SPSS21.0 software for statistical analysis, P0.05 difference is statistically significant. Results Study 1: according to the inclusion and exclusion criteria, 90 cases of patients, ES group 31 cases, of which E There were 19 cases in the S treatment group, 12 in the untreated group and 59 in the LS group, including 36 in the LS treatment group and 23 in the untreated group. The follow-up time was 12-96 months (median of 20 months), and the recurrence rates of second seizures in 1 years (3m, 6m, 9m, 12m) were compared between the groups and the subgroups: (1) the LS group was higher than the ES group (49.15%? 69.49%vs.25.81%? 38.71%). The difference was statistically significant (P0.05); (2) LS untreated group was higher than ES untreated group (56.52%? 73.91%vs.16.77%? 33.33%) and 3M, 12m time point difference was statistically significant (P0.05); (3) ES treatment group and untreated group, LS treatment group and untreated group, ES treatment group and LS treatment group, the difference was not statistically significant (P0.05). The incidence of epileptic relapse was highest at 3 months at different times, 3 to 6 months, 91.67% in 6 months, two in 76.59%. study, 79 in PSE patients according to the inclusion and exclusion criteria; the follow-up time was 12-100 months (median of 23 months); the number of epileptic seizures was 0.36~15 times per year (median 2 / year). All patients were treated with 1~3 AEDs treatment. Treatment: (1) single drug + combined therapy: the non attack rate was 40.51% (32/79), the effective rate was 48.10% (38/79), the total effective rate was 88.61% (70/79); (2) single drug treatment: no attack rate was 27.85% (22/79), the effective rate was 27.85% (22/79), the total effective rate was 55.70% (44/79); (3) combined treatment: no attack rate was 33.33% (10/30), the effective rate of treatment was 53.33% (16/30), and the rate of treatment was 33.33% (10/30). The total effective rate was 86.67% (26/30); (4) 40 cases of valproic acid in the whole follow-up period, 44 cases of levetiracetam, 1) with valproic acid, 1, 25% (10/40), 17.5% (7/40), the total effective rate of 42.5% (17 /40), 2) valproic acid + AEDs: without attack rate 28.57% (6/21), and efficiency of 57.14 The total effective rate was 85.71% (12/21) (18/21), with left acetacetam as an example: 1) single drug treatment: no attack rate was 27.27% (12/44), the effective rate was 25% (11/44), the total effective rate was 52.27% (23/44); 2) left acetacetam + other AEDs: free attack rate 42.86% (9/21), the effective rate of 42.86% (9/21), and the total effective rate of 85.71% (18/21). (5) no attack patients without hair. The time was mainly concentrated in 1~2 (81.25%); (6) in patients with no attack, single drug treatment was 22/32 (68.75%), 2 AEDs combined with 10/32 (31.25%), of which valproic acid single drug was treated with 10/32 (32.25%), its non attack dose was 500-1000mg/d 9/10 (90%), combined treatment 6/32 (18.75%), and its free treatment dose of 500-1000mg/ was 500-1000mg/ D 5/6 cases (83.33%); levetiracetam single drug treatment for 12/32 (37.50%), its non seizure treatment dose of 500-1000mg/d 11/12 (91.67%), combined treatment of 9/32 cases (28.13%), the free treatment dose of 500-1000mg/d 7/9 case (77.78%). Conclusion 1. after only one stroke early onset epileptic seizures can be temporarily delayed AEDs treatment, and suggest long-term AEDs after recurrence of AEDs. The early onset recurrence rate of late onset epileptic seizures was high, and it was suggested that the electroencephalogram of epileptic patients after the first AEDs treatment after the first onset of.2. stroke generally did not involve the background abnormalities, mainly the slow wave accompanied by epileptic waves, and the slow wave reaction to a certain extent of the brain damage. The frequency of the seizures in patients with PSE was lower (by AEDs). 2 times / year, 1~2 AEDs can get better control and get a long time without seizure and AEDs dosage is small.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1;R743.3

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