48例脑血管病后癫痫的临床分析

发布时间：2018-08-29 15:49

【摘要】：目的:脑血管病后癫痫(PSE)是脑血管病后最常见的并发症之一,由于癫痫领域对癫痫病因研究的重视,使得PSE的研究逐渐增加。脑血管病后癫痫患者在病理生理机制、危险因素、发作类型、转归上与其他癫痫患者不同,需要更多的关注与研究。本研究目的是在2001年国际抗癫痫联盟新的分类标准和2014年新的癫痫临床定义下,探究脑血管后癫痫患者的临床特征、危险因素、辅助检查及治疗的特点。方法:本研究回顾性分析2014年3月1日~2017年3月1日期间吉林大学第二医院神经内科、神经外科被诊断为脑血管病后癫痫的48例住院患者,依据卒中类型分为脑梗死组(CI)和脑出血组(ICH),依据脑血管病后癫痫首次发作时间分为早期发作组(脑血管病后1周内出现癫痫发作,ES)和晚期发作组(脑血管病后1周后出现癫痫发作,LS)。收集入选患者的一般资料、卒中类型、发作时间、发作类型、病灶部位、卒中严重程度(NIHSS评分)、辅助化验检查等临床资料,其中发作类型诊断符合2001年国际抗癫痫联盟(ILAE)癫痫发作分类的诊断标准。采用t检验和c2检验分析脑血管后癫痫患者的临床特征、危险因素、辅助检查及治疗的特点(P0.05有统计学意义)。结果:1.48例患者中,CI组37例,ICH组11例,ES组24例,LS组24例,两种分类下性别、年龄比较差异无统计学意义。ES组中发作发生在卒中后24小时内的22例;LS组中发作发生在卒中后6个月~1年的11例。2.48例患者中,局灶性发作11例,全面性发作12例,癫痫持续状态25例,发作类型与卒中类型、发作时间差异无统计学意义(P1=0.410,P2=0.470)。3.48例患者中,皮质受累31例,皮质下受累17例,单病灶16例,多病灶32例,皮质受累组与皮质下受累组、单病灶组与多病灶组比较,发作类型的差异有统计学意义(P1=0.036,P2=0.038)。4.ES组与LS组比较,卒中严重程度(NIHSS评分)差异有统计学意义(P=0.024)。5.在各项化验结果中,脑梗死组与脑出血组比较,差异无统计学意义;ES组与LS组比较,甘油三酯差异有统计学意义(P=0.009)。6.脑血管病后癫痫患者脑电图结果大部分异常,表现为慢波、尖波、棘波。7.48例患者中31例接受药物治疗,其中27例接受单药治疗,癫痫发作得到很好的控制。结论:1.早期发作的高峰在脑血管病后24小时内,晚期发作的高峰在脑血管病后第6-12个月。2.皮质受累、多发病灶、卒中严重程度均是脑血管病后癫痫的危险因素。3.脑电图出现慢波、尖波、棘波是脑血管病后癫痫发作的危险因素,尤其是尖波、棘波。
[Abstract]:Objective: (PSE) after cerebrovascular disease is one of the most common complications after cerebrovascular disease. Due to the attention paid to the study of epilepsy in the field of epilepsy, the study of PSE has gradually increased. Different from other epilepsy patients in pathophysiological mechanism, risk factors, seizure type and outcome after cerebrovascular disease, more attention and research are needed. The purpose of this study was to explore the clinical features, risk factors, adjuvant examination and treatment of patients with post-cerebrovascular epilepsy under the new classification criteria of the International Anti-Epilepsy Federation in 2001 and the new clinical definition of epilepsy in 2014. Methods: from March 1, 2014 to March 1, 2017, 48 inpatients diagnosed as post-cerebrovascular epilepsy in Department of Neurology, second Hospital of Jilin University, were retrospectively analyzed. According to the type of stroke, the patients were divided into cerebral infarction group (CI) and cerebral hemorrhage group (ICH),) according to the time of the first seizure after cerebrovascular disease, which were divided into early seizure group (onset of epilepsy within 1 week after cerebrovascular disease) and late attack group (1 after cerebrovascular disease). A seizure occurred after a week (LS). General data, stroke type, onset time, attack type, location of focus, severity of stroke (NIHSS score), auxiliary laboratory examination and other clinical data were collected. The diagnosis of seizure type was in accordance with the diagnostic criteria of the 2001 International Antiepileptic Federation (ILAE) Classification of Epilepsy seizures. T test and c2 test were used to analyze the clinical characteristics, risk factors, adjuvant examination and treatment of patients with epilepsy after cerebrovascular disease (P0.05). Results among the 48 patients, 37 cases were in CI group, 11 cases in ICH group and 24 cases in LS group. There was no significant difference in age. Among the 22 cases of LS with onset within 24 hours after stroke in es group, 11 cases had focal attack and 12 cases had comprehensive attack in 11 cases from 6 months to 1 year after stroke. There was no significant difference in seizure duration between seizure type and stroke type in 25 cases. There were 31 cases of cortical involvement, 17 cases of subcortical involvement, 16 cases of single focus, 32 cases of multi-focus, and 32 cases of cortical involvement and subcortical involvement. There was significant difference in attack type between single focus group and multi-focus group (P 1 0. 036 P 2 0. 038). 4. Compared with LS group, the severity of stroke (NIHSS score) was significantly different between es group and LS group (P 0. 024). There was no significant difference between cerebral infarction group and intracerebral hemorrhage group. The difference of triglyceride between es group and LS group was statistically significant (P0. 009). 6. The EEG results of the patients with epilepsy after cerebrovascular disease were mostly abnormal, including slow wave, sharp wave and spike wave. 31 of them received drug treatment, 27 of them received single drug treatment, and seizures were well controlled. Conclusion 1. The peak of early onset was within 24 hours after cerebrovascular disease, and the peak of late onset was 6-12 months. 2. Cortical involvement, multiple lesions and severity of stroke are risk factors of epilepsy after cerebrovascular disease. The occurrence of slow wave, sharp wave and spike wave in EEG is the risk factor of epileptic seizure after cerebrovascular disease, especially sharp wave and spike wave.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1;R743

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