抗癫痫药物单药与联合用药对老年人脑卒中后癫痫发作的疗效、预后及癫痫再发作的影响分析

Efficacy, prognosis and causes of recurrent epileptic seizures after antiepileptic drug monotherapy and combination therapy for senile post-stroke seizures

目的探讨抗癫痫药物(AEDs)单药与联合用药对脑卒中后癫痫发作的疗效、预后及癫痫再发作的影响。方法纳入2013年11月至2017年12月绍兴市中心医院收治的癫痫病程和AEDs疗程均>6个月的脑卒中后癫痫发作患者280例,根据患者病情状况分为早发性癫痫组和晚发性癫痫组,每组140例。依据AEDs治疗方案不同,进一步分为单药治疗组(丙戊酸钠)和联合治疗组(丙戊酸钠、奥卡西平联合左乙拉西坦)。结果早发性癫痫患者单药治疗比例明显高于晚发性癫痫患者,晚发性癫痫患者联合治疗比例明显高于早发性癫痫患者(χ^2=22.857,P<0.0001)。早发性癫痫患者单药与联合治疗后发作率及有效率比较,差异均有统计学意义[发作率:40.0%(36/90)比16.0%(8/50),χ^2=8.591,P=0.003;有效率:88.9%(80/90)比100.0%(50/50),χ^2=5.983,P=0.014];晚发性癫痫患者单药与联合治疗后发作率及有效率比较,差异均有统计学意义[发作率:40.0%(20/50)比82.2%(74/90),χ^2=25.974,P=0.000;有效率:64.0%(32/50)比87.8%(79/90),χ^2=11.065,P=0.000]。结论脑卒中后癫痫发作时间与卒中部位、类型及危险因素无关;早发性癫痫多为部分性发作,对AEDs疗效好,晚发性癫痫多为全面强直阵挛发作;未观察到单药与联合治疗在早发性或晚发性癫痫再发作及疗效中存在差别。

Objective To investigate the effect of single antiepileptic drugs(AEDs) and combination therapy on the effect of seizure after stroke, prognosis and recurrent seizures. Methods From November 2013 to December 2017, 280 patients with epilepsy and epilepsy that had been included in the epilepsy course and AEDs course for>6 months in Shaoxing Central Hospital were divided into early-onset epilepsy group and late-onset epilepsy group according to the patients' condition, with 140 cases in each group.According to different AEDs treatment regimens, they were further divided into monotherapy group(valproate) and combination therapy group(valproate, oxcarbazepine combined with levetiracetam). Results The proportion of monotherapy in the early-onset epilepsy group was significantly higher than that of the late-onset epilepsy group, and the proportion of the late-onset epilepsy group was significantly higher than that of the early-onset epilepsy group(χ^2=22.857, P<0.0001). The incidence and effectiveness of epilepsy patients after single-agent and combination therapy in the early-onset epilepsy group had statistically significant differences[onset rate: 40.0%(36/90) vs.16.0%(8/50),χ^2=8.591, P=0.003;effective rate: 88.9%(80/90) vs.100.0%(50/50),χ^2=5.983, P=0.014]. The incidence and effectiveness of single-agent and combination therapy in the late-onset epilepsy group had statistically significant differences [seizure rate: 40.0%(20/50) vs.82.2%(74/90),χ^2=25.974, P=0.000;effective rate: 64.0%(32/50) vs.87.8%(79/90),χ^2=11.065, P=0.000]. Conclusion The time of post-stroke epilepsy is not related with the site, type and risk factors of stroke;early epilepsy usually manifested partial seizures and had better curative effect of AEDs, and late epilepsy usually manifested overall tonic clonic seizure;there were no obvious difference in curative effect and recurrence rate of early and late epilepsy on single and combined AEDs treatment.