卒中后癫发作时间分布及影响因素的研究

Time Distribution and Influential Factor of Post-stroke Epileptic Seizures

目的分析卒中后癫发作时间分布特点,并对其影响因素进行研究。方法将122例卒中后癫发作患者分为早发性癫发作组(卒中后2周内出现癫发作)60例;晚发性癫发作组(卒中2周后出现癫发作)62例。进行单因素及多因素分析,研究患者的基础情况、卒中的危险因素、卒中的类型、癫发作的类型、发作频次、治疗等情况与早发及晚发的关系。结果性别、年龄、卒中危险因素以及脑电图改变在两组间无差异。缺血性卒中出血转化是卒中后癫发作早发的危险因素;早发性癫发作倾向于表现为全面性强直阵挛发作,晚发性癫发作倾向于表现为部分性发作;颞叶病变是卒中后癫发作晚发的危险因素;晚发性癫发作倾向于复发。早发性癫发作患者接受短期治疗的比例较高,晚发性癫发作患者接受长期治疗的比例较高。Logistic多元回归提示糖尿病是卒中后癫发作早发的危险因素(OR=2.664,95%CI=1.143～6.210,P=0.259)。结论糖尿病和缺血性卒中出血转化为卒中后癫发作早发的危险因素;而颞叶病变是卒中后癫发作晚发的危险因素,且晚发性癫发作更倾向于复发。

Objective To investigate the time distribution and influencing factors of post-stroke seizures in terms of seizure control and prevention purpose. Methods The demographic and clinical features, the seizure type and onset time, the infarct location and the electroencephalographic（EEG） findings of 60 stroke patients with a early seizures and of 62 ones with late seizures were retrospectively analysed and compared. Totally 122 cases diagnosed and admitted into hospital with post-stroke seizures by the largest stroke unit in China were included and followed up for at least a half to 5 years（from 2004-2008） in this study. All subjects were divided into two groups： early seizure group defined as seizures occurring within 14 days after acute stroke and later seizure group as seizures occurring 〉14 days after stroke. Univariately statistics and final multiple regression model（SPSS 13.0 for Windows） were used to find out its influencing factors respectively. Results Univariately statistics showed that early post-stroke seizures occurred most associatelly with hemorrhagic transformation of ischemic stroke and generalized tonic-clonic type seizures insults, while late post-stroke seizures showed some predisposition as associated with temporal lobe lesions and partial seizure type insults. Final multiple regression model study also indicated that the early one was more related to the predictor as diabetes odds ratio（OR=2.664; 95%CI 1.143-6.210）. Conclusion The most significant difference is the time of seizure onset, with a low recurrence rate. Diabetes and hemorrhagic transformation of ischemic stroke, generalized tonic-clonic insults in patients with early compared to those with late onset of stroke. Late seizures are more prone to temporal lesion and tend to recur clinically.