老年脑卒中患者癫痫发作的临床特点、脑电图表现及其危险因素分析

Clinical features and electroencephalographic findings of seizures in elderly patients with stroke and related risk factors

目的探讨老年人群脑卒中后癫痫(PSE)发作的临床特点、脑电图表现及其危险因素,为癫痫的早期预防提供依据。方法选取儋州市人民医院收治的脑卒中患者1485例,最终纳入患者992例,分析患者的临床特点及脑电图表现。根据脑卒中后癫痫发作情况,将其分为癫痫发作组87例和无癫痫发作组905例。应用单因素及多因素Logistic回归分析PSE的危险因素。结果 PSE的发生率为8.77%,其中早发型癫痫占55.17%,迟发型癫痫占44.83%。PSE发作的脑电图呈弥散性异常占26.44%,局限性异常占48.28%。单因素及多因素Logistic回归分析显示,高同型半胱氨酸血症、病灶部位、病灶范围、电解质紊乱、日常生活能力及NIHSS评分≥25分是PSE发作的独立危险因素,其OR(95%CI)值分别为2.063(1.146~3.125)、6.285(5.168~9.047)、4.725(3.684~6.835)、3.029(2.016~4.532)、2.538(1.568~3.562)和3.163(2.085~4.726)。结论老年人群脑卒中后癫痫发作的发生率较高,影响癫痫发作的危险因素较多,对存在危险因素的患者应高度警惕其癫痫的发生。

Objective To investigate the clinical features and electroencephalographic findings of post-stroke epilepsy （PSE） in elderly patients and related risk factors,and to provide a basis for early prevention of epilepsy.Methods A total of 1485 patients with stroke who were admitted to Danzhou People＆#39;s Hospital were enrolled and finally 992 patients were enrolled in the study.Their clinical features and electroencephalographic findings were analyzed.According to the presence or absence of PSE,these patients were divided into PSE group with 87 patients and non-PSE group with 905 patients.The univariate and multivariate logistic regression analyses were used to investigate the risk factors for PSE.Results The incidence rate of PSE was 8.77％,and among the patients with PSE,55.17％ had early-onset epilepsy and 44.83％ had delayed epilepsy.As for the electroencephalographic findings of PSE,26.44％ of all patients had diffuse abnormalities and 48.28％ had local abnormalities.The univariate and multivariate logistic regression analyses showed that hyperhomocysteinemia [odds ratio （OR） =2.063,95％ confidence interval （CI） 1.146-3.125）,location of lesion （OR =6.285,95％ CI 5.168-9.047）,extent of lesions （OR =4.725,95％ CI 3.684-6.835）,electrolyte disturbance （OR =3.029,95％ CI 2.016-4.532）,activities of daily living （OR =2.538,95％ CI 1.568-3.562）,and NIH Stroke Scale score ≥ 25 （OR =3.163,95％ CI 2.085-4.726） were independent risk factors for PSE.Conclusions PSE has a high incidence rate in elderly patients with many risk factors,and the development of epilepsy should be closely monitored in patients with related risk factors.