基于真实世界研究的丙戊酸钠、左乙拉西坦在缺血性卒中后 早期癫痫发作的疗效及疗程评价研究

Evaluation of the Efficacy and Treatment Course of Sodium Valproate and Levetiracetam in Early-Onset Seizures After Ischemic Stroke Based on a Real World Study.

目的评价丙戊酸钠、左乙拉西坦在缺血性卒中后早期癫痫发作的疗效及最佳疗程。方法收集我院2012年1月至2022年2月神经内科确诊急性缺血性卒中后早期癫痫发作、仅使用丙戊酸钠或左乙拉西坦抗癫痫治疗的住院患者82例,回顾性分析患者的人口学体征、实验室检测、影像学检查、病情严重程度及治疗情况。通过电话或面对面随访82例患者抗癫痫药物使用时长以及缺血性卒中1周以后是否再发癫痫。根据用药种类和时长将82例患者分为丙戊酸钠组(37例,其中短疗程组20例、长疗程组17例)、左乙拉西坦组(45例,其中短疗程组19例、长疗程组26例)。采用倾向性得分加权的方法平衡不同比较组间的协变量均衡性,并在具有协变量均衡性的伪人群样本中比较丙戊酸钠、左乙拉西坦在缺血性卒中后早期癫痫发作的疗效,探索缺血性卒中后早期癫痫发作的最佳治疗疗程。结果82例研究对象平均年龄(66.33±10.83)岁,其中男53例,女29例。有32例患者缺血性卒中1周后再次出现癫痫发作。丙戊酸钠组与左乙拉西坦组癫痫再发率比较,左乙拉西坦组患者出现癫痫再发的风险高于丙戊酸钠组(OR左乙拉西坦=2.276,P=0.012);丙戊酸钠短期组与左乙拉西坦短期组癫痫再发率比较,丙戊酸钠短疗程相对于左乙拉西坦短疗程对于控制癫痫再发的差异无统计学意义(OR丙戊酸钠短疗程=0.873,P=0.798);丙戊酸钠长疗程组与左乙拉西坦长疗程组癫痫再发率比较,丙戊酸钠长疗程组患者出现癫痫再发的风险低于左乙拉西坦长疗程组(OR丙戊酸钠长疗程=0.288,P=0.007);丙戊酸钠长疗程组与短疗程组癫痫再发率比较,丙戊酸钠疗程的长短对于控制癫痫再发的效果差异无统计学意义(OR长疗程=1.166,P=0.783)。结论总体及长疗程上,丙戊酸钠在治疗缺血性卒中后早期癫痫发作控制癫痫再发方面优于左乙拉西坦;短疗程中,丙戊酸钠与左乙拉西坦在控制癫痫再发方面效果相当。但丙戊酸钠疗程的长短对于控制癫痫再发效果无明显差异。

Objective To evaluate the efficacy and the best course of treatment of sodium valproate and levetiracetam in early-onset seizures after ischemic stroke.Methods A total of 82 inpatients diagnosed with early-onset seizures after acute ischemic stroke and treated with only sodium valproate or levetiracetam antiepileptic therapy were collected from January 2012 to February 2022 in the Second Peoples’Hospital of Yibin.Demographic signs,experimental tests,image examination,disease severity and treatment were reviewed retrospectively.82 patients were followed up by telephone or face-to-face for the duration of antiepileptic drugs and whether seizures recurred one week after cerebral infarction.According to the type and duration of medication,82 patients were divided into sodium valproate group(37 cases,including 20 cases for the short-term treatment group and 17 cases for the long-term treatment group)and levetiracetam group(45 cases,including 19 cases for the short-term treatment group and 26 cases for the long-term treatment group).A weighted bias score was used to balance the covariate equilibrium between different comparison groups,and the efficacy of sodium valproate and levetiracetam in early epileptic seizures after ischemic stroke was compared in a sample of pseudo population with covariate equilibrium,so as to explore the best course of treatment for early epileptic seizures after ischemic stroke.Results The 82 subjects had an average age of(66.33±10.83)years,including 53 males and 29 females.32 patients had recurrent seizures one week after cerebral infarction.Comparing the recurrence rate of seizures between the sodium valproate group and the levetiracetam group,patients in the levetiracetam group had a higher risk of recurrence of seizures than those in the sodium valproate group(OR levetiracetam=2.276,P=0.012).Comparing the recurrence rate of seizures between the short-term treatment sodium valproate group and the levetiracetam short-term treatment group,there was no significant difference between them in controlling the recurrence of seizures(OR sodium valproate short-term treatment=0.873,P=0.798).Comparing the recurrence rate of seizures between the long-term sodium valproate group and the long-term levetiracetam group,the risk of recurrence of seizures in the long-term sodium valproate group was lower than that in the long-term levetiracetam group(OR long-term valproate=0.288,P=0.007).Compared with the recurrence rate of seizures in the long-term sodium valproate group and the short-term valproate group,the effect of the length of valproate on the control of recurrence of seizures was not statistically significant(OR long-term=1.166,P=0.783).Conclusion In general and long-term treatment,sodium valproate is better than levetiracetam in the treatment of early-onset seizures after ischemic stroke and the control of seizures recurrence;In the short-term treatment,valproate and levetiracetam have the same effect in controlling the recurrence of seizures.However,the duration of valproate sodium treatment has no significant difference in the control effect of seizures recurrence.