缺血性中风患者中风后癫痫发作的发生率和风险因素

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-10-12 DOI:10.1016/j.jstrokecerebrovasdis.2024.108072

Emma M. Federico BS , Kate Carroll MD , Margaret McGrath MD , Melanie Walker MD , Isaac Stafstrom MD , Erica Skinner BS , Margot Maraghe BS , Michael R. Levitt MD

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引用次数: 0

摘要

背景卒中后癫痫发作（PSS）会增加缺血性卒中后的发病率和死亡率，但目前还缺乏对其发病率和风险因素的全面了解。我们报告了一家机构的 PSS 发生率和风险因素。方法对一家综合卒中中心 2018 年至 2022 年间的成人急性缺血性卒中患者进行了一项回顾性队列研究。排除了有癫痫发作史、入院时又发生卒中或卒中发生后 7 天内死亡的患者。早期 PSS 定义为卒中发生后≤7 天的新发作，而晚期 PSS 则发生在卒中发生后>7 天。结果1211 名参与者符合纳入标准。患者平均年龄为 67.82 岁，主要为男性（58.7%）、白人（72.6%）和非西班牙裔（91.9%）。PSS 发病率为 8.8%（n = 106），其中 53.8%（n = 57）为早期，46.2%（n = 49）为晚期。双变量分析表明，年龄较小、糖尿病、美国国立卫生研究院卒中量表（NIHSS）基线、阿尔伯塔省卒中计划早期计算机断层扫描评分≤5、皮质受累和出血性转化对 PSS 的发生有显著影响。多变量 cox 比例危险分析确定皮质受累（危险比 [HR]：2.31，95 % 置信区间 [CI] [1.29，4.14]）、NIHSS ≥ 21（HR：1.82，95 % CI [1.02，3.22]）和年龄较小（HR：0.97，95 % CI [0.96，0.98]）是 PSS 的重要预测因素。出血性转变、皮质受累、NIHSS 高和年龄小是预测 PSS 的重要因素。

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Incidence and risk factors of post-stroke seizure among ischemic stroke patients

Background

Post-stroke seizure (PSS) increases morbidity and mortality after ischemic stroke, but a comprehensive understanding of its incidence and risk factors is lacking. We report the rate and risk factors of PSS at a single institution.

Methods

A retrospective cohort study of adult acute ischemic stroke patients between 2018 and 2022 at a comprehensive stroke center was conducted. Patients with a history of seizures, additional stroke during index admission, or death within 7 days of stroke onset were excluded. Early PSS was defined as a new seizure occurring ≤7 days after stroke onset, while late PSS occurred >7 days after stroke onset. Multivariable logistic regression and cox proportional hazard analysis was conducted.

Results

1211 participants met inclusion criteria. Patients were a mean age of 67.82 and were primarily male (58.7 %), white (72.6 %), and non-Hispanic (91.9 %). Incidence of PSS was 8.8 % (n = 106), of which 53.8 % (n = 57) were early and 46.2 % (n = 49) were late. Bivariate analysis identified younger age, diabetes, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early Computed Tomography Score ≤5, cortical involvement, and hemorrhagic transformation as significant in the development of PSS. Multivariable cox proportional hazard analysis identified cortical involvement (hazard ratio [HR]: 2.31, 95 % confidence interval [CI] [1,29, 4.14]), NIHSS ≥ 21 (HR: 1.82, 95 % CI [1.02, 3.22]),and younger age (HR: 0.97, 95 % CI [0.96, 0.98]) as significant PSS predictors.

Conclusion

PSS occurred in 8.8 % of patients presenting with ischemic stroke. Hemorrhagic transformation, cortical involvement, high NIHSS, and younger age were significant predictors of PSS.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.