癫痫杂志

癫痫杂志

卒中后癫痫发作的长期抗癫痫药物治疗时机

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目的探讨卒中后癫痫发作的长期抗癫痫药物(AEDs)治疗时机, 进而指导临床治疗。 方法纳入2014年9月-2016年8月天津医科大学总医院神经内科住院及门诊就诊的至少有一次卒中后癫痫发作, 且发作后病程≥12个月, 长期服用或未服用AEDs治疗的患者90例。入组后采用回顾性分析与继续随访相结合的方法, 根据卒中后首次癫痫发作的时间分为两组: ①早发性癫痫发作(Early-onset seizure, ES)组(卒中后≤2周)31例; ②晚发性癫痫发作(Late-onset seizure, LS)组(卒中后>2周)59例。再根据首次癫痫发作后是否给予AEDs治疗分为ES治疗组19例, ES未治疗组12例; LS治疗组36例, LS未治疗组23例。对比分析各组及亚组在不同随访时间点发生第二次癫痫发作的再发率及好发时间。 结果90例患者随访时间12~96个月(中位数20个月), 12个月内不同随访时间点(3、6、9及12个月)发生第二次癫痫发作的再发率在各组及亚组之间的比较: ① LS组高于ES组(49.15%~69.49% vs. 25.81%~38.71%), 差异有统计学意义(P<0.05); ② LS未治疗组高于ES未治疗组(56.52%~73.91% vs. 16.77%~33.33%)且在3、12个月时间点差异有统计学意义(P<0.05); ③ ES治疗组与ES未治疗组、LS治疗组与LS未治疗组、ES治疗组与LS治疗组比较, 差异无统计学意义(P>0.05)。整个随访期内ES组及LS组癫痫再发者在不同时间的发生比率3个月最高, 3~6个月次之, 6个月内分别高达91.67%、76.59%。 结论仅一次卒中后ES可暂缓AEDs治疗, 再发后建议长期AEDs治疗; 而LS较ES的再发率高, 建议首次发作后开始长期的AEDs治疗。

ObjectiveThis study aimed to explore the timing of the long-term antiepileptic drugs (AEDs) therapy in patients with stroke related seizures. MethodsWe enrolled 90 Patients with post-stroke seizures who diagnosed in neurology and epilepsy specialist clinic of Tianjin Medical University General Hospital and followed up for at least 12 months from September 2014 to August 2016. The patients were divided into early-onset seizure group (occurring within 2 weeks of stroke) and late-onset seizure group (occurring after 2 weeks of stroke).The two groups were subdivided into treated and untreated group after the first seizure. ResultsThe patients were followed up for 12~96m (median 20m). 31 patients in ES group, 19 of which in treated group and 12 of which in untreated group. 59 patients in LS group, 36 of which in treated group and 23 of cases in untreated group. The recurrence rate of second seizures occurred in each group and the comparison between the subgroups in the 3rd, 6th, 9th and 12th mouth of follow-up as follows. 1 LS group compared with the group of ES, the recurrence rate of second seizures was high (25.81%~38.71% vs. 49.15%~69.49%), and there was statistical difference (P < 0.05). 2 The recurrence rate of ES in untreated group was lower than that in untreated LS group (16.77% 33.33% vs. 56.52% 73.91%), but only in 3m and 12m the difference was statistically significant (P < 0.05). 3 There was on statistically significant different in ES treated group compared to untreated group, LS treated group compared to untreated group, ES treated group compared to LS treated group (P > 0.05). Both in group of ES and LS, The ratio of seizure recurred patients at different time points during follow-up period was highest at the time of 3m, 3 6m followed, within six months respectively as high as 91.67% and 76.59%. ConclusionOnly one early-onset seizure after stroke can be suspended long-term AEDs treatment, once it recurred that indicates the need for treatment. However, the recurrence rate of late-onset seizure was higher than that of early-onset seizure and it should be given long term AEDs treatment after the first seizure.

关键词: 卒中后癫痫; 早发性癫痫发作; 晚发性癫痫发作; 治疗时机; 抗癫痫药物

Key words: Post-stroke seizures; Early-onset seizure; Late-onset seizure; Timing of treatment; Antiepileptic drugs

引用本文: 李立婷, 毓青, 燕鑫鑫, 余丹华, 陈英, 姚晓娟, 杨卫东, 陈旨娟. 卒中后癫痫发作的长期抗癫痫药物治疗时机. 癫痫杂志, 2017, 3(1): 22-26. doi: 10.7507/2096-0247.20170003 复制

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