蛛网膜下腔出血继发癫痫发作临床分析

Clinical Analysis of Secondary Epilepsy after Subarachnoid Hemorrhage

目的：探讨蛛网膜下腔出血（SAH）继发癫痫的临床特点。方法：回顾性分析近17年来经CT证实的134例SAH患者中18例继发性癫痫患者的临床资料,重点观察癫痫发作类型与SAH之Fisher分级间的关系。全组均采用脱水降颅压、止血、抗感染等综合治疗,对于癫痫发作2次及以上的病人同时给予抗癫痫治疗。结果：于SAH72 h内继发癫痫发作12例,于病程第4～15天继发癫痫发作6例。18例中,全身性强直-阵挛发作（强直组）10例,简单部分性运动发作（简单组）4例,复杂部分性运动发作（复杂组）4例;除强直组与简单组Fisher分级比较,差异有统计学意义（P〈0.05）外,其余组间比较差异无统计学意义（P〉0.05）。根据GOS量表评定疗效,本组优9例,良2例,中2例,死亡5例。结论：SAH继发癫痫多发生在SAH早期,且以强直-阵挛发作为多见;其发作类型与SAH出血量和出血波及大脑皮质的范围密切相关。

Objective： To investigate the clinical features of secondary epilepsy after subarachnoid hemorrhage.Methods： The clinical data from 18 cases with secondary epilepsy in 134 SAH patients,who were confirmed by CT scan in recent 17 years,was analyzed retrospectively.We especially focused on the relationship between the mode of seizure and Fisher grade of SAH.All the patients received the combined therapy,which included depressing intracranial pressure by dehydration,hemostasis and anti-infection,etc.Meanwhile,those with more than 2 seizure attack accepted anti-epileptic treatment.Results：12 cases of secondary epilepsy occurred within 72 hours after SAH,6 cases in 4 to 15 days.10 of 18 patients had generalized tonic-clonic seizure（group 1）,4 had simple partial seizures（group 2）,and other 4 patients had complex partial seizures（group 3）.There was statistical difference between group 1 and group 2.According to GOS effect grade,9 of them were excellent,2 fine,2 fair,5 dead.Conclusions：Secondary epilepsy usually occurred in early period after SAH,and the generalized tonic-clonic seizure is the most common type.The type of attack is related to the volume of hemorrhage and area of cortex influenced.