结合新癫痫定义评估脑卒中后首发癫痫患者再发风险分析

Risk assessmenof epilepsy recurrence of patientwith single post-stroke epilepsy based on the new epilepsy definition

目的探讨脑卒中后首次发生癫痫后再发风险的评估预测。方法回顾性分析我院1580例脑卒中后发生癫痫58例患者的临床资料。结果1580例脑卒中后发生癫痫58例，发生率3．67％，其中早发型癫痫6例（0．38％），迟发型癫痫52例（3．29％）；其中仅1次癫痫发作31例（A组），1年内两次及以上发作27例（B组）。A组首次癫痫发作早发型2例（A1），晚发型29例（A2）；B组首次癫痫发作早发型3例（B1），晚发型24例（B2），两组间癫痫发作类型差异无统计学意义（x2=0．001，P〉0．05）。A组有13例病灶位于皮层，18例病灶位于皮层下方；B组有17例病灶位于皮层，10例病灶位于皮层下方，由此可见，B组病灶以皮层处居多，而A组病灶以皮层下方居多，但差异未见有统计学意义（x2=2．555，P〉0．05）。A组出血性卒中12例，缺血性卒中19例；B组出血性卒中lo例，缺血性卒中17例，两组间脑卒中类型差异无统计学意义（x2=0．017，P〉0．05）。A组癫痫节律性慢波及痫样放电分别为11例、2例，B组分别为11例、13例。B组约有51．8％的再发癫痫患者存在感染史。结论脑卒中尤其是出血性卒中，首次癫痫发作为晚发型癫痫病例，如果其脑电活动存在明显异常慢节律或痫样放电，靠近皮层容易引起癫痫再发作，故在卒中后首次癫痫发作后应积极的给予抗癫痫药物治疗。

Objective To analyze the recurrence risk of patientsingle post-stroke epilepsy. Method Fifty-eighcaseof epilepsy aftestroke in Pinggu DistricHospital of Beijing were enrolled in thistudy and theihistory clinical information were retrospectively collected. All patientwere divided into single attack group （group） and two omore attack group （group）. ResultThere were 3.67% （58/1580） stroke patientwere developed epilepsy. Among them,0. 38% （6/58） of patientwere developed seizurein early stage, and 3.29% （52/58） in late stage. Thirty-one caseoccurred epilepsy once within one yearin group and 27 caseoccurred epilepsy more than twice with one yeain group. Initiate epilepsy onseof 2 cases（ A1 ） waaearly stage and 29 cases（A2） alate stage in group. Initiate epilepsy onseof 3 case（ B1 ） waaearly stage and 24 cases（B2） alate stage in group. There wano significandifference in term of typeof epilepsy between two group（ X2 = 0. 001, P 〉 0. 05 ）. The lesionsite of 13 casewalocated cortex and 18 casewalocated in below cortex in group, in group, the lesionsite walocated in cortex of 17 easeobelow cortex of 10 cases, and the difference wanosignificant（ X2 = 2. 555, P 〉 0. 05 ）. The hemorrhagistroke and ischemistroke were 12 and 19 casein group, 10 and 17 casein group, and there wano significandifference between two group（ X2 = 0. 017, P 〉 0.05 ）. Rhythm of slow wave and the epileptiform dischargewere 11 and 2 easein group, tl and 13 casein group. Abou51.8% of the patientwith recurrence of epilepsy had history of infection in group. Conclusion Fostroke patients, especially hemorrhagistroke, firsseizure ilateonseepilepsy eases. If the electrical activity of the brain iabnormal slow rhythm oepileptiform discharges, close to the cortex imore likely to cause epilepsy recurrence. Iisupposed to giving positive antiepileptidrug treatmenin the firsepilepsy aftestroke.