急性脑梗死后继发癫痫的临床特点及影响因素分析

Clinical features and influencing factors of secondary epilepsy after acute cerebral infarction

目的探讨急性脑梗死后继发癫痫的临床特点及影响因素分析,为其预防和治疗提供理论支持。方法回顾性分析80例急性脑梗死患者的临床资料,其中21例继发癫痫的患者为病例组,余59例未继发癫痫的患者为对照组,统计急性脑梗死后继发癫痫的临床症状,采用多因素Logisitic回归分析急性脑梗死后继发癫痫的危险因素。结果21例急性脑梗死后继发癫痫患者中,中、重度神经功能缺损患者占85.71%(18/21),单次癫痫发作患者占66.67%(14/21),癫痫分类以全身强直阵挛发作为主(52.38%,11/21),病灶部位在皮层上的占61.90%(13/21)。病例组和对照组中不同国立卫生研究院卒中量表(NIHSS)评分、病灶部位、病灶大小、受累动脉系统的人数比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,患者NIHSS评分≥15分、病灶位于皮层上、病灶≥5 cm、颈动脉循环受累是急性脑梗死继发癫痫的独立危险因素。结论急性脑梗死继发癫痫的患者表现为中度以上神经功能缺损,病灶位于皮层上,以全身强直阵挛发作、单次、早发性癫痫为主。NIHSS评分≥15分、病灶位于皮层上、病灶≥5 cm、颈动脉循环受累的患者急性脑梗死后易继发癫痫。

Objective To explore the clinical features and influencing factors of secondary epilepsy after acute cerebral infarction(ACI)so as to provide theoretical support for its prevention and treatment.Methods The clinical data of 80 patients with ACI were retrospectively analyzed,including 21 cases with secondary epilepsy(experimental group)and 59 cases without secondary epilepsy(control group).The clinical symptoms of secondary epilepsy after ACI were analyzed.Multivariate logistic regression analysis was applied to examine risk factors.Results Among the 21 patients with secondary epilepsy after ACI,the proportions of patients with moderate to severe neurological deficits and single epilepsy attack were 85.71%(18/21)and 66.67%(14/21)respectively.In terms of epilepsy types,generalized tonic-clonic seizure(GTCS)was in the majority(52.38%,11/21),and the lesions located at the cortex accounted for 61.90%(13/21).There were significant differences in the number of patients with different scores of the NIHSS,lesion sites,lesion size and involved arterial system between the experimental group and control group(P<0.05).Multivariate logistic regression analysis showed that NIHSS scored over 15 points,lesions located at the cortex,lesions not shorter than 5 cm and involvement of carotid circulatory system were independent risk factors of secondary epilepsy after ACI.Conclusions There aremoderate or more severe neurological deficits in patients with secondary epilepsy after ACI.The lesions are located at the cortex,which is mainly on GTCS,single and early-onset epilepsy.NIHSS score not lower than 15 points,lesions located at the cortex,lesions not shorter than 5 cm and involvement of carotid circulatory system are independent risk factors of secondary epilepsy after ACI.