脑梗死后癫痫发作相关因素分析

摘要

Objective:To analyze retrospectively the risk factors and predictors of post-cerebral infraction epilepsy(PIE)and refractory epilepsy in patients with cerebral infraction. Method:In a hospital based study,the patients with cerebral infraction were reviewed retrospectively between the January of 1993 and December of 2011. Related factors were evaluated including age,sex,seizure types,neuroimaging,electroencephalogram(EEG)in intermittent period,clinical symptoms,etc. Result:628 patients with cerebral infraction were enrolled,whose median age was 63.2(range 36-89)years old. PIE occurred in 59(9.39%)patients;and 18 of whom had partial seizure. Significant risk factors for PIE included age(OR=3.73,95%CI 2.65-5.30, P=0.021),disturbance of consciousness level(OR=5.61,95%CI 2.42-10.36,P=0.013),Damaged of temporal lobe(OR=8.25,95%CI 5.80-26.53, P=0.000),spike discharge in EEG(OR=11.70,95%CI 8.52-35.03,P=0.000). The refractory epilepsy occurred in 16 patients. The significant risk factors of refractory PIE,included focal seizures(OR=3.09,95%CI 2.24-10.91 P=0.032),status epilepticus(OR=4.78,95%CI 1.68-9.32,P=0.011) and poor controlled seizure(OR=6.13,95%CI 4.55-13.35,P=0.001)during acute phase,multifocal spikes discharge in EEG(OR=6.65,95%CI 8.02-16.19,P=0.036),Damaged of temporal lobe(OR=2.33,95%CI 1.75-8.27,P=0.001),however,early thrombolysis therapy(OR=2.39,95%CI 1.15-5.87,P=0.029)and longer time to initial seizure(OR=4.74,95%CI 3.15-10.32,P=0.015)could significantly reduce the incidence of refractory epilepsy in PIE patients. Conclusion:PIE is a common complication,especially refractory epilepsy. It is related with many factors.%　　目的：对影响脑梗死后癫痫（PIE）发作及难治性脑梗死后癫痫的相关因素进行回顾性分析。方法：对1993年1月-2011年12月在本院住院诊断的脑梗死患者进行回顾性研究。以脑梗死后癫痫及难治性癫痫为评价指标。分析因素包括：年龄、性别、癫痫发作类型、首次发作出现的时间、间隙期脑电图、神经影像学资料、早期溶栓治疗等。结果：628例患者纳入本研究，年龄36~89岁，平均63.2岁，其中59例出现脑梗死后癫痫（9.39%），其中18例为部分性发作。难治性癫痫出现的相关危险因素：年龄（OR=3.73，95%CI 2.65~5.30， P=0.021），意识障碍（OR=5.61，95%CI 2.42~10.36，P=0.013），颞叶受损（OR=8.25，95%CI 5.80~26.53，P=0.000），间隙期脑电图癫痫样放电（OR=11.70，95%CI 8.52~35.03，P=0.000）等。难治性癫痫16例，发生的相关因素：部分性发作（OR=3.09，95%CI 2.24~10.91，P=0.032），早期癫痫持续状态（OR=4.78，95%CI 1.68~9.32，P=0.011），间隙期脑电图多灶性棘慢波（OR=6.65，95%CI 8.02~16.19，P=0.036），颞叶受损（OR=2.33，95%CI 1.75~8.27，P=0.001）和急性期难以控制的发作（OR=6.13，95%CI 4.55~13.35，P=0.001）。早期溶栓治疗（OR=2.39，95%CI 1.15-5.87，P=0.029）和首次发作延迟（OR=4.74，95%CI 3.15~10.32，P=0.015）可以减少难治性癫痫的出现风险。结论：脑梗死后癫痫是脑梗死后患者常见的并发症，特别是难治性癫痫较为多见，有多种因素与其有相关性。