脑炎急性期癫痫发作进展为脑炎后癫痫的影响因素分析

Influencing Factors Involved in the Progression of Epileptic Seizure at the Acute Phase of Encephalitis into Postencephalitic Epilepsy

目的探讨脑炎急性期癫痫发作进展为脑炎后癫痫(Postencephalitic epilepsy,PE)的影响因素。方法回顾性分析自2010年1月-2019年6月在云南省第一人民医院及昆明医科大学第一附属医院住院诊断自身免疫性脑炎(autoimmune encephalitis,AE)、病毒性脑炎急性期伴有癫痫发作并使用免疫治疗的141例患者的临床资料。根据是否进展为PE将141例患者分为2组;通过Logistic回归分析探讨影响脑炎急性期癫痫发作患者进展为PE的因素。结果141例患者有25例进展为PE,发生率17.73%。多因素Logistic回归分析显示:影响脑炎急性期癫痫发作进展为PE的危险因素包括治疗前有发热(OR=3.288,95%CI=1.116~9.687,P=0.031)及癫痫发作频率≥10次/d(OR=4.564,95%CI=1.263~16.491,P=0.021);相对于服用半年以下抗癫痫药物(Antiepileptic drugs,AEDs)治疗疗程,服用0.5 y~1 y(OR=0.672,95%CI=0.064~7.024,P=0.740)及服用1 y以上(OR=3.049,95%CI=0.906~10.261,P=0.072)均不影响PE的发展。相对于无发热的患者,有发热的患者中更易出现意识障碍(P<0.001),癫痫持续状态(P=0.023)及头部核磁共振成像(magnetic resonance imaging,MRI)显示炎性病灶(P=0.007)。结论治疗前有发热及癫痫发作频率≥10次/d是PE发生的危险因素;相对于治疗前无发热的患者,有发热的患者中更易出现意识障碍、癫痫持续状态及头部MRI显示炎性病灶;服用AEDs治疗疗程的长短并不影响PE的发展,由此推测长期服用AEDs以避免PE的发生是没有必要的。

Objective To investigate the factors that affect the progression of epileptic seizure at the acute phase of encephalitis into postencephalitic epilepsy.Methods A retrospective analysis was conducted to investigate the clinical data of 141 patients who were admitted to the First People’s Hospital of Yunnan Province and the First Affiliated Hospital of Kunming Medical University from January 2010 to June 2019,diagnosed as autoimmune encephalitis or viral encephalitis in the acute phase with epileptic seizure and treated with immunotherapy.The 141 patients were divided into 2 groups according to whether their epileptic seizure progressed to postencephalitic epilepsy.Logistic regression analysis was applied to investigate the factors that affect the progression of epileptic seizure at the acute phase of encephalitis into postencephalitic epilepsy.Results The epileptic seizure of 25 patients(17.73%of all 141 patients)progressed to postencephalitic epilepsy.The results of multi-factor Logistic regression analysis show that the risk factors involved in the progression of epileptic seizure included:a fever before treatment(OR=3.288,95%CI=1.116~9.687,P=0.031)and high seizure frequency(≥10 times/day)(OR=4.564,95%CI=1.263~16.491,P=0.021).Compared with a course of antiepileptic drugs for less than 6 months,a course of antiepileptic drugs for 6-12 months(OR=0.672,95%CI=0.064~7.024,P=0.740)or above(OR=3.049,95%CI=0.906~10.261,P=0.072)did not affect the development of postencephalitic epilepsy.Compared with the patients with no fever before treatment,those with fever were more prone to disturbance of consciousness(P<0.001),status epilepticus(P=0.023)and a head MRI showing inflammatory lesions(P=0.007).Conclusion Therefore,a fever before treatment and high seizure frequency(≥10 times/day)are identified as the risk factors causing postencephalitic epilepsy.The length of course of antiepileptic drugs does not affect the incidence of postencephalitic epilepsy,suggesting that it is unnecessary to prevent postencephalitic epilepsy by long-term use of antiepileptic drugs.