本文選題：卒中后癲癇復發(fā)　切入點：臨床特點　出處：《青島大學》2017年碩士論文

【摘要】：研究目的很多沒有卒中知識的人經(jīng)常會因為發(fā)作相似而誤認為癲癇發(fā)作為卒中。癲癇發(fā)作通常是短暫的,可以在短時間內恢復正常。而卒中是一個長期且?guī)缀蹩倳z留某些永久性損害的病種。當患者卒中時會通過各種形式來表現(xiàn)對大腦造成損傷。例如卒中能影響運動,語言,行為或記憶和情感等。還有一個卒中的影響不太明顯的就是卒中后癲癇發(fā)作的幾率增加。近來老年腦卒中成為癲癇發(fā)作的重要原因之一,而癲癇成為腦卒中后常見的并發(fā)癥,被稱為“腦卒中后癲癇”。雖然許多研究已評估過卒中后癲癇的臨床風險因素和電生理特點,但對于卒中后癲癇復發(fā)的臨床風險因素和電生理特點目前卻沒有可靠的數(shù)據(jù)。我們通過比較卒中后癲癇復發(fā)與無復發(fā)患者之間的臨床、電生理及卒中后的治療方案,來分析卒中后癲癇患者的復發(fā)相關危險因素及獨立預測因素。研究方法在癲癇發(fā)作的復發(fā)研究中,收集我院2013年12月-2016年12月(中值368天)3年期間收治入我院神經(jīng)內科的卒中后癲癇患者的住院病史資料及門診隨訪資料。以首次癲癇發(fā)作為起始時間,通過368天的隨訪了解患者癲癇發(fā)作是否復發(fā),計算癲癇發(fā)作復發(fā)率,比較單次發(fā)作組和復發(fā)組的臨床特點,采用Kaplan-Meier生存曲線分析估算在90、180和360天的累積復發(fā)率。腦卒中后癲癇復發(fā)的獨立預測因子是由Cox比例風險回歸分析確定。結果共對104例卒中后癲癇患者(男71例,平均年齡72.1±11.2歲)進行了分析研究,其中復發(fā)的患者31例(30%)。36例(33.6%)卒中后癲癇患者一年內有癲癇發(fā)作。采用Log-rank檢驗分析,與卒中后癲癇發(fā)作及癲癇復發(fā)顯著相關的因素包括:先前有過卒中后癲癇病史、丙戊酸鈉的單藥治療、多種抗癲癇藥物聯(lián)合治療、額葉皮質病變以及患者出院時改良的Rankin量表評分越高(P均0.05)。年齡小于74歲(HR 2.38,95%CI 1.02 5.90)、丙戊酸鈉單藥治療(HR 3.86,95%CI 1.30 12.62)和以抽搐收治入院(HR 3.87,95%CI 1.35 12.76)是復發(fā)的獨立預測因子。復發(fā)患者抽搐發(fā)作類型最主要為部分性發(fā)作且并沒有繼發(fā)全身性癲癇者24例(29%)。腦電圖為局灶或單側慢波表現(xiàn)最常見18例(30%),癇樣放電主要為局灶性棘慢波7例(17.1%),局灶性癲癇持續(xù)性狀態(tài)4例(4%)和1例局灶性運動型發(fā)作。結論與卒中后癲癇發(fā)作及癲癇復發(fā)顯著相關的因素包括:先前有過卒中后癲癇病史、丙戊酸鈉的單藥治療、多種抗癲癇藥物聯(lián)合治療、額葉皮質病變以及患者出院時改良的Rankin量表評分越高(P均0.05)。PSE復發(fā)的患者的預測因素與年齡小于74歲、丙戊酸鈉單藥治療和以抽搐收治入院有關。部分性發(fā)作和局灶(或單側)慢波在復發(fā)患者中最常見。腦電圖的改變能夠提供動態(tài)實時的神經(jīng)電生理。這些結果是在假設和前瞻性隨機、雙盲情況下研究,以評估卒中后癲癇的最安全和最有效的二級預防藥物。
[Abstract]:Objective many people with no knowledge of stroke often mistake seizures for stroke because of similar seizures.Seizures are usually brief and can return to normal in a short period of time.Stroke is a long-term disease that almost always leaves some permanent damage.When a patient has a stroke, it can be expressed in various ways to damage the brain.Stroke, for example, can affect movement, language, behavior or memory, and emotion.Another less obvious effect of stroke is an increase in the risk of seizures after stroke.Recently, senile stroke has become one of the important causes of epilepsy, and epilepsy has become a common complication after stroke, which is called "post-stroke epilepsy".Although many studies have evaluated the clinical risk factors and electrophysiological characteristics of post-stroke epilepsy, there are no reliable data on the clinical risk factors and electrophysiological characteristics of post-stroke epilepsy recurrence.In order to analyze the risk factors and independent predictive factors of recurrent epilepsy after stroke, we compared the clinical, electrophysiological and post-stroke treatment protocols between patients with recurrent epilepsy after stroke and those without recurrence.Methods in the study of relapse of epileptic seizures, the history and follow-up data of post-stroke epilepsy patients admitted to the Department of Neurology in our hospital during the 3-year period from December 2013 to December 2016 (median 368 days) were collected.With the first seizure as the starting time, the patients were followed up for 368 days to find out whether the seizure recurred, calculate the relapse rate, and compare the clinical characteristics between the single seizure group and the recurrent group.Kaplan-Meier survival curve analysis was used to estimate the cumulative recurrence rate at 90180 and 360 days.The independent predictor of recurrent epilepsy after stroke was determined by Cox proportional risk regression analysis.Results A total of 104 patients with post-stroke epilepsy (71 males with an average age of 72.1 鹵11.2 years) were studied. Among them, 31 patients with recurrent epilepsy had seizures within one year.By Log-rank test, the factors associated with post-stroke epileptic seizures and recurrent epilepsy included: previous history of post-stroke epilepsy, monotherapy of valproate sodium, and combined treatment of various antiepileptic drugs, including: previous history of epilepsy after stroke, single drug therapy of valproate sodium, and combined treatment of multiple antiepileptic drugs.The higher the cortical lesion of frontal lobe and the higher the score of modified Rankin scale at discharge, the higher the score (P < 0.05).HR2.3895 (CI 1.02 5.90), valproate alone (HR 3.86 ~ 95CI 1.30 ~ 12.62) and twitch admitted to hospital (HR 3.87 ~ 95CI 1.35 ~ 12.76) were independent predictors of recurrence.The main types of recurrent seizures were partial seizures and no secondary systemic epilepsy in 24 patients.Electroencephalogram (EEG) was the most common local or unilateral slow wave manifestation in 18 cases (30%), epileptiform discharge was mainly local spinoside slow wave (7 cases), focal epileptic persistent state (4 cases) and focal motor attack (1 case).Conclusion the factors associated with post-stroke epileptic seizures and recurrent epilepsy include previous history of post-stroke epilepsy, monotherapy of valproate sodium, and combination of various antiepileptic drugs.The higher the score of the modified Rankin scale at the time of discharge, the higher the predictive factors of the patients with recurrent 0.05).PSE were related to the age of patients less than 74 years old, valproate monotherapy and the admission of convulsions.Partial seizures and localized (or unilateral) slow waves are most common in recurrent patients.Changes in EEG can provide dynamic, real-time neurophysiology.These results were studied in a hypothetical and prospective randomized, double-blind study to assess the safest and most effective secondary prophylaxis of post-stroke epilepsy.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3;R742.1

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本文編號：1710422