■中风后癫痫(PSE)是老年人群的重要问题,中风是这个人口统计学中癫痫的主要原因。几个因素显示出与发生PSE的风险有一致的关联,包括皮质病变,初始卒中严重程度,年龄较小,以及早期癫痫发作的发生。这项研究的主要目标是两个:(1)确定PSE的发生率和(2)在卒中后患者的前瞻性队列中确定与PSE相关的危险因素。
■进行了一项前瞻性单医院研究,包括诊断为急性缺血性和出血性中风的患者。患者从入院时开始随访2年(或直至死亡)。收集有关癫痫发作和复发性中风的数据。使用Kaplan-Meyer曲线评估PSE发病率和死亡率。从组间分析中选择PSE和死亡率的可能预测因子,并进行多变量回归分析。
■我们的研究共纳入了424例诊断为急性卒中的患者。其中,97例(23%)出现早期卒中后癫痫发作,28例患者(6.6%)发生PSE。发现出血性中风后发生PSE的累积风险为15.4%,缺血性中风后为8.7%。在具有竞争性死亡风险的多变量精细和灰色回归中,在缺血队列中发生PSE的重要预测因素是分水岭梗死(HR6.01,95%CI2.29-15.77,p<0.001)和出院时的低Barthel指数(HR0.98,CI0.96-0.99,p=0.04).此外,最终发生PSE的患者在出院时恢复较慢,神经系统状况较差.与非PSE组相比,PSE组的美国国立卫生研究院卒中量表(NIHSS)的住院动态明显更差(p=0.01)。
■与类似研究中常见报道相比,早期癫痫发作的病例比例更高。分水岭卒中和出院时低Barthel指数均被确定为缺血性卒中PSE的独立危险因素。该研究揭示了个体在经历缺血性卒中后可能易患卒中后癫痫的潜在机制。
UNASSIGNED: Post-stroke epilepsy (PSE) is a significant concern in the elderly population, with stroke being a leading cause of epilepsy in this demographic. Several factors have shown consistent associations with the risk of developing PSE, including cortical lesions, initial stroke severity, younger age, and the occurrence of early seizures. The primary objectives of this study were two-fold: (1) to determine the incidence of PSE and (2) to identify the risk factors associated with PSE in a prospective cohort of post-stroke patients.
UNASSIGNED: A prospective single-hospital study was conducted, involving patients diagnosed with acute ischemic and hemorrhagic stroke. The patients were followed up for 2 years (or until death) from the time of admission. Data about seizure occurrence and recurrent stroke were collected. Kaplan-Meyer curves were used for the assessment of PSE incidence and mortality. Possible predictors of PSE and mortality were selected from between-group analysis and tested in multivariable regressions.
UNASSIGNED: Our study enrolled a total of 424 patients diagnosed with acute stroke. Among them, 97 cases (23%) experienced early post-stroke seizures, and 28 patients (6.6%) developed PSE. The cumulative risks of developing PSE were found to be 15.4% after hemorrhagic stroke and 8.7% after ischemic stroke. In multivariable fine and gray regression with competitive risk of death, significant predictors for developing PSE in the ischemic cohort were watershed infarction (HR 6.01, 95% CI 2.29-15.77, p < 0.001) and low Barthel index at discharge (HR 0.98, CI 0.96-0.99, p = 0.04). Furthermore, patients who eventually developed PSE showed slower recovery and presented a worse neurologic status at the time of discharge. The in-hospital dynamics of the National Institutes of Health Stroke Scale (NIHSS) were significantly worse in the PSE group compared to the non-PSE group (p = 0.01).
UNASSIGNED: A higher proportion of cases experienced early seizures compared to what has been commonly reported in similar studies. Watershed stroke and low Barthel index at discharge were both identified as independent risk factors of PSE in ischemic strokes, which sheds light on the underlying mechanisms that may predispose individuals to post-stroke epilepsy after experiencing an ischemic stroke.