颅内动脉瘤破裂血管内治疗后癫痫发作的风险:系统回顾和荟萃分析。

Journal of epilepsy research Pub Date : 2020-12-31 eCollection Date: 2020-12-01 DOI:10.14581/jer.20009
Ezequiel García-Ballestas, William A Florez-Perdomo, Robert M Starke, Andrei Fernandes Joaquim, Amit Agrawal, Ravish Rajiv Keni, Luis-Rafael Moscote-Salazar
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引用次数: 1

摘要

动脉瘤性蛛网膜下腔出血(aSAH)的癫痫发作已被描述为继发于SAH,皮质功能改变,血管痉挛和治疗效果的结果。癫痫发作是aSAH神经系统预后的重要临床决定因素之一。各种研究都支持血管内治疗与显微外科治疗相比,未来癫痫发作风险更低的观点,但没有确凿的证据支持或反对aSAH患者在血管内治疗后与显微外科治疗相比癫痫发作的发生。对颅内动脉瘤破裂后血管内处理(卷取)后癫痫发作的风险进行系统回顾和荟萃分析。检索PubMed、MEDLINE、Embase和Scopus电子数据库自成立至2020年2月的文献,检索词为癫痫发作、颅内动脉瘤、栓塞,无约束条件。采用随机效应模型合并数据,结果抽象为优势比(ORs)和95%置信区间(CI),异质性报告为卡方。荟萃分析纳入了涉及3077例患者的5项研究。在血管内处理aSAH后,癫痫发作的风险随着临床严重程度的加重而增加(世界神经外科联合会量表或Hunt and Hess) (or, 3.34;95% ci, 2.69-4.16;pppp
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk of Seizures after Endovascular Management of Ruptured Intracranial Aneurysms: A Systematic Review and Meta-analysis.

Seizures in aneurysmal subarachnoid haemorrhage (aSAH) have been described secondary to SAH, changes in cortical function, vasospasm and as a result of treatment effects. Seizures are one of the important clinical determinants in neurological outcome of aSAH. Various studies support the notion of less risk of future seizures in endovascular treatment as compared to the microsurgical clipping, yet there is no conclusive evidence in favour or against the seizure occurrence in aSAH patients after endovascular treatment as compared to the microsurgical treatment. To carry out a systematic review and meta-analysis of the risk of seizures after endovascular management (coiling) of ruptured intracranial aneurysms. A literature search was performed in electronic database of PubMed, MEDLINE, Embase, and Scopus from inception to February 2020, using the terms Seizure, Intracranial aneurysms, embolization, with no constraints applied. Data were pooled using a random-effect model, results were abstracted as odds ratios (ORs) and 95% confidence interval (CI), and heterogeneity was reported as Chi-square. Five studies involving 3,077 patients were included in the meta-analysis. After endovascular management of aSAH, seizure risk was increased by a worse clinical severity (World Federation of Neurosurgery scale or Hunt and Hess) (OR, 3.34; 95% CI, 2.69-4.16; p<0.00001), severe vasospasm (OR, 2.20; 95% CI, 1.67-2.92; p<0.00001), cerebral infarction (OR, 5.19; 95% CI, 3.23-8.35; p<0.00001), and cerebral edema (OR, 1.79; 95% CI, 1.37-2.34; p<0.0000). Worse clinical severity, vasospasm, cerebral infarction and cerebral oedema are significant risk factors for the development of seizures after endovascular intervention in aSAH. The mechanism for this correlation is not clear.

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