脑炎后癫痫发作相关因素分析

Study on the related factors of post-encephalitic epilepsy

目的对影响脑炎后癫痫（PEE）发作及难治性PEE的相关因素进行回顾性分析。方法对1995年1月至2010年12月在我院住院及门诊诊断的237例病毒性脑炎患者进行回顾性研究。以PEE及难治性癫痫为评价指标。分析因素包括：年龄、性别、癫痫发作类型、首次发作出现的时间、间隙期脑电图、神经影像资料、早期激素治疗等。结果237例患者纳入本研究，平均年龄26．3（15～57）岁，103例患者出现PEE（43．46％），其中67例为部分性发作。PEE出现的相关危险因素：年龄（OR=3．72，95％CI2．70～5．25，P=0．018）、意识障碍（OR=5．37，95％CI 2．43～13．03，p=0．012）、皮质受损（OR=11．42，95％CI5．94～31．27，P：0．000）、间隙期脑电图癫痫样放电（OR=18．04，95％CI7．30～48．38，P=0．000）和急性期抽搐发作（OR=32．68，95％CI9．62～97．59，P=0．000）等。难治性癫痫61例，发生的相关因素：部分性发作（OR=4．09，95％CI2．14～9．10，P=0．021）、急性期癫痫持续状态（OR=4．48，95％CI1．89～8．07，P=0．017）、间隙期脑电图多灶性棘慢波（OR=5．53，95％CI2．91～10．07，P=0．006）、皮质受损（OR=2．33，95％CI1．37～7．72，P=0．028）和急性期难以控制的发作（OR=6．17，95％CI3．52～11．34，P=0．001）。而早期激素治疗（OR=2．19，95％CI1．11～4．87，P=0．037）和首次发作出现的时间延迟（OR=4．40，95％C13．19～11．62，P=0．014）可以减少难治性癫痫的出现风险。结论PEE是脑炎后患者常见的并发症，特别是难治性癫痫尤为多见，有多重因素与其具有相关性。

Objective To analyze retrospectively the risk factors and predictors of post-encephalitic epilepsy （PEE） and refractory epilepsy in patients with encephalitis. Methods In a hospital based study, the patients with encephalitis were reviewed retrospectively between the January of 1995 and December of 2010. Related factors were evaluated including age, sex, seizure types, neuroimaging, electroencephalogram （EEG） in intermittent period, clinical symptoms, consciousness level, initial seizure and steroid hormone therapy, etc. Results 237 patients with encephalitis were enrolled, whose median age was 26. 3 （ range 15-57） years old. PEE occurred in 103 （43.46%） patients; and 67 of whom had partial seizure. Significant risk factors for PEE included age （OR =3.72, 95% CI 2. 70-5.25 ,P =0. 018） ,disturbance of consciousness level（ OR = 5.37, 95% CI 1 2.43-13.03, P = 0. 012 ） , cortical lesion in imaging （ OR = 11.42, 95% CI 5.94-31.27,P = 0. 000）, spike discharges in EEG （ OR = 18.04, 95 % CI 7.30-48.38, P = 0. 000 ） and initial seizures in acute phase （ OR = 32. 68, 95% CI 9. 62-97. 59, P = 0. 000 ）. The refractory epilepsy occurred in 61 patients. The significant risk factors of refractory PEE included focal seizures（ OR = 4. 09, 95% CI 2. 14-9. 10, P = 0. 021 ）, status epilepticus （ OR = 4. 48, 95% CI 1.89-- 8.07 ,P =0. 017） and poor controlled seizure （ OR = 6. 17, 95% CI 3.52-11.34,P = 0. 001 ） during acute phase, muhifocal spikes discharge in EEG（ OR = 5. 53, 95% CI 2. 91-10. 07, P = 0. 006）, cortical lesion in neuroimaging （ OR = 2. 33, 95% CI 1.37-7.72, P = 0. 028 ）, however, early steroid hormone therapy （ OR = 2. 19, 95% CI 1.11-4. 87, P = 0. 037 ） and longer time to initial seizure （ OR = 4.40, 95% CI 3.19-11.62 ,P = 0. 014） could significantly reduced the incidence of refractory epilepsy in PEE patients. Conclusion Our data indicated that PEE occur in 43.46% patients especially in younger patients with disturbance of consciousness level, cortical lesion in imaging, spike discharges in EEG and initial seizures in acute phase. And the risk factors for refractory PEE are also discussed.