缺血性脑卒中后癫痫发作的患病率、风险因素和预后

Mairla Maracaba Moreira, J. B. C. de Andrade, Carlos Eduardo Lenis Rodriguez, Davi Said Araújo, Flávia Paiva Rolim, Marla Rochana Braga Monteiro, Norberto Anizio Frota, F. O. Lima, G. S. Silva
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引用次数: 0

摘要

导言和目的:癫痫发作(ES)是公认的脑卒中并发症,通常与广泛的缺血区域和皮质损伤有关。尽管进行了深入研究,但文献中关于脑卒中后癫痫发作的发生率、风险因素和功能影响的报道却大相径庭。我们的目的是评估卒中后 ES 的预测因素及其对出院时临床预后的影响。研究方法2015年至2017年我院卒中科收治的急性缺血性卒中(AIS)患者均符合本研究的条件。我们建立了一个多变量逻辑回归模型,以评估急性症状性癫痫发作(AS)的相关变量。我们将 AS 定义为在住院(卒中单元出院)期间发生的、无临床或脑电图证据的癫痫发作史的癫痫发作。结果:最终分析纳入了 492 例患者。患者平均年龄为 66.7 (±14.4) 岁,56% 为男性。38名患者(7.7%)在院内出现临床ES,其中全前循环综合征患者的ES发生率更高。NIH 卒中量表评分(几率比 [OR] 1.07,95% 置信区间 [CI],p = .03)和无症状出血转化(HT)(OR:3.53,95% CI:1.38-8.99,p = .01)可独立预测 ES。我们没有发现癫痫发作与出院时的不良预后(改良Rankin量表3-6)之间存在关联(OR1.26,95% CI:0.3-5.32,p = .75)。癫痫发作患者的住院时间较长(18.5 [11-35] 天 vs. 9 [7-14] 天)。结论:入院时 NIH 卒中量表评分较高或出现症状性 HT 的患者发生院内 ES 的风险较高。然而,AIS 后出现急性症状 ES 并不能独立预测出院时的不良功能预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevalence, Risk Factors and Prognosis of Seizures After Ischemic Stroke
Introduction and objectives: Epileptic seizures (ES) are a recognized complication of stroke, commonly associated with extensive ischemic regions and cortical damage. Despite thorough investigation, reports on the incidence, risk factors, and functional implications of post-stroke ES vary widely in the literature. We aimed to evaluate the predictive factors for post-stroke ES and their effects on the clinical outcome at hospital discharge. Methods: Patients with acute ischemic stroke (AIS) admitted to our stroke unit from 2015 to 2017 were eligible to this study. A multivariable logistic regression modeling was built to assess associated variables with acute symptomatic seizures (AS). We defined AS as seizures that occurred within the period of hospitalization (stroke unit discharge) without a history of seizures with clinical or electroencephalographic evidence. Results: Four hundred ninety-two were included in the final analysis. The patients had a mean of 66.7 (±14.4) years; 56% were male. Thirty-eight (7.7%) patients experienced clinical ES in-hospital, with a higher incidence in those with total anterior circulation syndrome. The NIH Stroke Scale score (odds ratio [OR] 1.07, 95% confidence interval [CI], p = .03) and symptomatic hemorrhagic transformation (HT) (OR: 3.53, 95% CI: 1.38–8.99, p = .01) independently predicted ES. We did not find an association between the occurrence of seizures and unfavorable outcomes (Modified Rankin Scale 3–6) at discharge (OR1.26, 95% CI: 0.3–5.32, p = .75). Patients with seizures had a longer hospital stay (18.5 [11–35] vs. 9 [7–14] days). Conclusions: Patients presenting higher NIH Stroke Scale scores upon admission or experiencing symptomatic HT face an increased risk of in-hospital ES. Nonetheless, acute symptomatic ES following AIS does not independently predict adverse functional outcomes at discharge.
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