脑卒中后癫痫发作的发生率及危险因素分析

Analysis of the incidence and risk factors of post-stroke epilepsy

目的:探讨脑卒中后癫痫(post-stroke epilepsy,PSE)的发病率及PSE发作的相关危险因素,早期发现PSE发作的危险人群,为癫痫发作早期预防提供依据。方法:收集2019年1—12月在南通大学附属医院神经内科首次因脑卒中住院的既往无癫痫病史的687例患者的人口统计学资料、基线资料、影像学特征等,并通过电话随访的方式将所有患者按是否发生癫痫分为PSE组和非癫痫对照(non-epileptic control,NEC)组,记录癫痫患者首次癫痫发作的时间及癫痫发作形式。分析PSE的发病率,应用多因素Logistic回归分析筛选影响PSE发作的独立危险因素。结果:符合纳入标准获得随访患者共687例,其中诊断为PSE有32例(4.66%)。Logistic回归分析,以PSE发作作为研究结局时,皮层脑卒中、脑卒中病灶最大横截面积、入院格拉斯哥昏迷评分与癫痫发作有相关性(P=0.012、0.026、P<0.001)。结论:皮层脑卒中、大面积脑梗死、入院时昏迷程度重是PSE的独立危险因素,并对PSE的发生有一定的预测作用。

Objective:To investigate the incidence and risk factors of post-stroke epilepsy(PSE)and the risk factors associated with seizures,to identify early the risk group for PSE,and to provide a basis for early seizure prevention.Methods:From January to December 2019,the study recruited 687 patients without previous epilepsy who were first hospitalized for stroke in Department of Neurology,the Affiliated Hospital of Nantong University,and collected detailed demographic data,baseline data,imaging features.All patients were divided into the PSE group and the non-epileptic control(NEC)group according to whether epilepsy occurred by telephone follow-up,and the time of the first seizure and the form of seizure were collected.The incidence of PSE was statistically analyzed,and independent risk factors for PSE were screened using multifactorial Logistic regression analysis.Results:A total of 687 patients who met the inclusion criteria were monitored in this study.Thirty-two(4.66%)patients were diagnosed with PSE.Logistic regression analysis showed that when PSE attack was taken as the study outcome,cortical stroke,maximum cross-sectional area of the stroke lesion,Glasgow coma scale score on admission were correlated with seizure(P=0.012,P=0.026 and P<0.001).Conclusions:Cortical stroke,massive cerebral infarction,and heavy coma on admission may be independent risk factors for PSE and are predictive of the occurrence of PSE.