老年首次痫性发作的病因分析

Etiology of elderly patients with first epileptic seizures

目的调查老年期首次痫性发作的病因及再发风险。方法收集181例老年期首次出现痫性发作病人的临床资料并随访2~10年,分析其病因及再发风险。结果老年首次痫性发作的病因中癫痫为主要原因,共156例(86.19%),病因依次为脑梗死(35.91%)、脑出血(16.58%)、脑外伤(9.95%)、隐源性(7.73%)、脑肿瘤(5.53%)、变性性疾病(4.97%)等,再次发作比例为99.35%。非癫痫疾病所致痫性发作25例(13.81%),病因依次为糖尿病(7.18%)、慢性酒精中毒或戒断(2.21%)、低钠血症(2.21%)、特殊药物使用(1.66%)、肾功能衰竭(0.55%)等,再次发作比例为16.00%。结论老年痫性发作的病因以癫痫为主,少部分为非癫痫性疾病,脑血管病是老年痫性发作的首要病因,其次为脑外伤、肿瘤、变性性疾病及隐源性等,再发比例高,多需药物治疗。非癫痫疾病所致常见病因为糖尿病等,病因治疗后复发比例低。

Objective To investigate the etiology and recurrent risk in elderly patients with first epileptic seizures.Methods 181 elderly patients with first epileptic seizures were retrospectively studied.Clinical data were collected and the patients were followed up for 2-10 years.The etiology and recurrent risk were analyzed.Results The main reason for inducing first epileptic seizures was epilepsy with 156 cases（86.19%）,caused by cerebral infarction（35.91%）,cerebral hemorrhage（16.58%）,traumatic brain injury（9.95%）,cryptogenic epilepsy（7.73%）,brain tumors（5.53%）,degenerative diseases（4.97%）.25 cases（13.81%） with first epileptic seizures were induced by non-epileptic disease,such as diabetes（7.18%）,chronic alcoholism or withdrawal（2.21%）,hyponatremia（2.21%）,special drug use（1.66%）,renal failure（0.55%）.Conclusions The main etiology of elderly patients with first epileptic seizures is epilepsy,which need to be controlled by anti-epilepsy drugs.The primary causes of epilepsy are cerebrovascular diseases,followed by brain trauma,tumor,degenerative diseases and cryptogenic epilepsy.Non-epileptic disease is mainly caused by diabetes,with low relapse after treatment of primary disease.