本文選題：卒中后癲癇 + 早發(fā)性癲癇發(fā)作��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討卒中后癲癇發(fā)作的長(zhǎng)期抗癲癇藥物(AEDs)治療時(shí)機(jī),進(jìn)一步研究卒中后癲癇(Post-Stroke Epilepsy,PSE)患者AEDs治療轉(zhuǎn)歸進(jìn)而指導(dǎo)臨床。方法:研究一:納入2014年9月-2016年8月天津醫(yī)科大學(xué)總醫(yī)院神經(jīng)內(nèi)科住院及門診就診的至少有一次卒中后癲癇發(fā)作,且發(fā)作后隨訪時(shí)間≥12m,長(zhǎng)期服用或未服用AEDs治療的患者,根據(jù)卒中后首次癲癇發(fā)作的時(shí)間分為2組:(1)早發(fā)性癲癇發(fā)作(Early-onset seizure,ES)組(卒中后≤2周);(2)晚發(fā)性癲癇發(fā)作(Late-onset seizure,LS)組(卒中后2周)。通過(guò)癲癇門診隨診及電話隨訪方式收集癲癇患者的基本資料(年齡、性別、急性卒中時(shí)間、卒中類型等)及癲癇相關(guān)資料(首次癲癇發(fā)作的時(shí)間、距卒中發(fā)生的時(shí)間、癲癇發(fā)作類型、發(fā)作后病程、首次癲癇發(fā)作后是否給予長(zhǎng)期的正規(guī)AEDs治療、治療藥物、劑量、患者服藥依從性等)并建立電子病歷管理系統(tǒng)。再根據(jù)首次癲癇發(fā)作后是否給予AED治療分為ES治療組、未治療組,LS治療組、未治療組。對(duì)比分析各組及亞組在不同隨訪時(shí)間點(diǎn)發(fā)生第二次癲癇發(fā)作的再發(fā)率及好發(fā)時(shí)間。研究二:納入2014年9月-2017年3月天津醫(yī)科大學(xué)總醫(yī)院神經(jīng)內(nèi)科住院及門診就診至少兩次卒中后癲癇發(fā)作及符合卒中后癲癇定義并長(zhǎng)期服用AEDs的患者。無(wú)發(fā)作為隨訪期內(nèi)≥12m未出現(xiàn)癲癇發(fā)作;有效為其發(fā)作較基線水平(3個(gè)最長(zhǎng)發(fā)作間歇期或1年內(nèi)的發(fā)作總數(shù))減少≥50%以上,尚不能達(dá)到無(wú)發(fā)作;總有效率包括無(wú)發(fā)作率及有效率。通過(guò)天津醫(yī)科大學(xué)總醫(yī)院癲癇專科門診復(fù)診及電話隨訪方式,記錄PSE患者的年齡、性別、隨訪時(shí)間、卒中類型、癲癇發(fā)作形式及次數(shù)、腦電圖異常分布、長(zhǎng)期服用AEDs種類等情況。通過(guò)隨訪期內(nèi)經(jīng)AEDs治療的無(wú)發(fā)作率、有效率、總有效率及無(wú)發(fā)作患者AEDs的治療情況,研究AEDs的治療轉(zhuǎn)歸。應(yīng)用SPSS21.0軟件進(jìn)行統(tǒng)計(jì)分析,p0.05差異有統(tǒng)計(jì)學(xué)意義。結(jié)果研究一:根據(jù)納入及排除標(biāo)準(zhǔn),納入患者90例,ES組31例,其中ES治療組19例,未治療組12例;LS組59例,其中LS治療組36例,未治療組23例。隨訪時(shí)間12-96個(gè)月(中位數(shù)20個(gè)月),1年內(nèi)不同隨訪時(shí)間點(diǎn)(3m、6m、9m、12m)發(fā)生第二次癲癇發(fā)作的再發(fā)率在各組及亞組之間的比較:(1)LS組高于ES組(49.15%?69.49%vs.25.81%?38.71%),差異有統(tǒng)計(jì)學(xué)意義(p0.05);(2)LS未治療組高于ES未治療組(56.52%?73.91%vs.16.77%?33.33%)且在3m、12m時(shí)間點(diǎn)差異有統(tǒng)計(jì)學(xué)意義(p0.05);(3)ES治療組與未治療組、LS治療組與未治療組、ES治療組與LS治療組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。整個(gè)隨訪期內(nèi)ES組及LS組癲癇再發(fā)者在不同時(shí)間的發(fā)生率3個(gè)月最高,3?6個(gè)月次之,6個(gè)月內(nèi)分別高達(dá)91.67%、76.59%。研究二:根據(jù)納入及排除標(biāo)準(zhǔn),納入PSE患者79例;隨訪時(shí)間12-100個(gè)月(中位數(shù)23個(gè)月);癲癇發(fā)作次數(shù)0.36~15次/年(中位數(shù)2次/年)。所有患者服用1~3種AEDs治療:(1)單藥+聯(lián)合治療:無(wú)發(fā)作率為40.51%(32/79),治療有效率為48.10%(38/79),總有效率為88.61%(70/79);(2)單藥治療:無(wú)發(fā)作率為27.85%(22/79),治療有效率27.85%(22/79),總有效率為55.70%(44/79);(3)聯(lián)合治療:無(wú)發(fā)作率為33.33%(10/30),治療有效率為53.33%(16/30),總有效率為86.67%(26/30);(4)整個(gè)隨訪期內(nèi)服用丙戊酸類的患者40例,左乙拉西坦的患者44例。以丙戊酸類為例:1)單藥治療:無(wú)發(fā)作率為25%(10/40),有效率為17.5%(7/40),總有效率為42.5%(17/40);2)丙戊酸類+其他AEDs:無(wú)發(fā)作率為28.57%(6/21),有效率為57.14%(12/21),總有效率為85.71%(18/21)。以左乙拉西坦為例:1)單藥治療:無(wú)發(fā)作率為27.27%(12/44),有效率為25%(11/44),總有效率為52.27%(23/44);2)左乙拉西坦+其他AEDs:無(wú)發(fā)作率為42.86%(9/21),有效率為42.86%(9/21),總有效率為85.71%(18/21)。(5)無(wú)發(fā)作患者的無(wú)發(fā)作時(shí)間主要集中在1~2年(81.25%);(6)在無(wú)發(fā)作患者中,單藥治療22/32例(68.75%),2種AEDs聯(lián)合治療10/32例(31.25%),其中丙戊酸單藥治療10/32例(32.25%),其無(wú)發(fā)作的治療劑量為500-1000mg/d 9/10例(90%),聯(lián)合治療6/32例(18.75%),其無(wú)發(fā)作的治療劑量為500-1000mg/d 5/6例(83.33%);左乙拉西坦單藥治療12/32例(37.50%),其無(wú)發(fā)作的治療劑量為500-1000mg/d 11/12例(91.67%),聯(lián)合治療9/32例(28.13%),其無(wú)發(fā)作的治療劑量為500-1000mg/d 7/9例(77.78%)。結(jié)論1.僅一次卒中后早發(fā)性癲癇發(fā)作可暫緩AEDs治療,再發(fā)后建議長(zhǎng)期AEDs治療;而晚發(fā)性癲癇發(fā)作較早發(fā)性的再發(fā)率高,建議首次發(fā)作后開(kāi)始長(zhǎng)期AEDs治療。2.卒中后癲癇患者的腦電圖表現(xiàn)一般不累及背景異常,主要表現(xiàn)為慢波伴癲癇波,慢波反應(yīng)一定程度的腦部損害。經(jīng)AEDs治療PSE患者的每年的發(fā)作頻率較低(2次/年),1~2種AEDs便可得到較好的控制,并得到長(zhǎng)時(shí)間的無(wú)發(fā)作且AEDs的用藥劑量較小。
[Abstract]:Objective to explore the timing of long-term antiepileptic drug (AEDs) treatment for epileptic seizures after stroke and to further study the outcome of AEDs treatment for patients with post stroke Post-Stroke Epilepsy (PSE) and then guide the clinic. Epileptic seizures after stroke, and follow-up time of more than 12M, patients who had long or not taken AEDs for the first time were divided into 2 groups according to the first seizure after stroke: (1) premature seizures (Early-onset seizure, ES) group (after stroke less than 2 weeks); (2) late onset seizures (Late-onset seizure, LS) group (2 weeks after stroke). Epilepsy (2 weeks after stroke). The basic information of epileptic patients (age, sex, acute stroke time, stroke type, etc.) and epilepsy related data (the time of the first seizure, the time of the onset of the stroke, the type of epileptic seizure, the course of the onset of the seizure, and the long-term regular AEDs treatment after the first epileptic seizure, and the treatment of the drug, " Dose, patient compliance, etc.) and establish an electronic medical record management system. Then according to the first epileptic seizures, AED treatment was given to the ES treatment group, the untreated group, the LS treatment group, and the untreated group. The recurrence rate and time of second epileptic seizures in each group and the subgroup were compared and analyzed at different time points. Study two: 2014 In September -2017, -2017 March, the General Hospital Affiliated to Tianjin Medical University neurology department of Neurology hospitalized at least two stroke epileptic seizures and patients with post-stroke epilepsy definition and long-term use of AEDs. No onset of epilepsy during the follow-up period was no more than 12m. It was effective for its attack compared with baseline (3 longest episodes or 1 years of onset. The total number was less than 50% or more, and the total effective rate was no seizure. The total effective rate included no attack rate and efficiency. The age, sex, follow-up time, type of stroke, the form and frequency of epileptic seizures, abnormal distribution of EEG, and long-term use of AED were recorded in the clinic of the General Hospital Affiliated to Tianjin Medical University in the epilepsy specialist clinic and telephone follow-up. S type and other conditions. Through the follow-up period of AEDs treatment without attack rate, efficiency, total efficiency and non attack patients with AEDs treatment, study the treatment of AEDs, the application of SPSS21.0 software for statistical analysis, P0.05 difference is statistically significant. Results Study 1: according to the inclusion and exclusion criteria, 90 cases of patients, ES group 31 cases, of which E There were 19 cases in the S treatment group, 12 in the untreated group and 59 in the LS group, including 36 in the LS treatment group and 23 in the untreated group. The follow-up time was 12-96 months (median of 20 months), and the recurrence rates of second seizures in 1 years (3m, 6m, 9m, 12m) were compared between the groups and the subgroups: (1) the LS group was higher than the ES group (49.15%? 69.49%vs.25.81%? 38.71%). The difference was statistically significant (P0.05); (2) LS untreated group was higher than ES untreated group (56.52%? 73.91%vs.16.77%? 33.33%) and 3M, 12m time point difference was statistically significant (P0.05); (3) ES treatment group and untreated group, LS treatment group and untreated group, ES treatment group and LS treatment group, the difference was not statistically significant (P0.05). The incidence of epileptic relapse was highest at 3 months at different times, 3 to 6 months, 91.67% in 6 months, two in 76.59%. study, 79 in PSE patients according to the inclusion and exclusion criteria; the follow-up time was 12-100 months (median of 23 months); the number of epileptic seizures was 0.36~15 times per year (median 2 / year). All patients were treated with 1~3 AEDs treatment. Treatment: (1) single drug + combined therapy: the non attack rate was 40.51% (32/79), the effective rate was 48.10% (38/79), the total effective rate was 88.61% (70/79); (2) single drug treatment: no attack rate was 27.85% (22/79), the effective rate was 27.85% (22/79), the total effective rate was 55.70% (44/79); (3) combined treatment: no attack rate was 33.33% (10/30), the effective rate of treatment was 53.33% (16/30), and the rate of treatment was 33.33% (10/30). The total effective rate was 86.67% (26/30); (4) 40 cases of valproic acid in the whole follow-up period, 44 cases of levetiracetam, 1) with valproic acid, 1, 25% (10/40), 17.5% (7/40), the total effective rate of 42.5% (17 /40), 2) valproic acid + AEDs: without attack rate 28.57% (6/21), and efficiency of 57.14 The total effective rate was 85.71% (12/21) (18/21), with left acetacetam as an example: 1) single drug treatment: no attack rate was 27.27% (12/44), the effective rate was 25% (11/44), the total effective rate was 52.27% (23/44); 2) left acetacetam + other AEDs: free attack rate 42.86% (9/21), the effective rate of 42.86% (9/21), and the total effective rate of 85.71% (18/21). (5) no attack patients without hair. The time was mainly concentrated in 1~2 (81.25%); (6) in patients with no attack, single drug treatment was 22/32 (68.75%), 2 AEDs combined with 10/32 (31.25%), of which valproic acid single drug was treated with 10/32 (32.25%), its non attack dose was 500-1000mg/d 9/10 (90%), combined treatment 6/32 (18.75%), and its free treatment dose of 500-1000mg/ was 500-1000mg/ D 5/6 cases (83.33%); levetiracetam single drug treatment for 12/32 (37.50%), its non seizure treatment dose of 500-1000mg/d 11/12 (91.67%), combined treatment of 9/32 cases (28.13%), the free treatment dose of 500-1000mg/d 7/9 case (77.78%). Conclusion 1. after only one stroke early onset epileptic seizures can be temporarily delayed AEDs treatment, and suggest long-term AEDs after recurrence of AEDs. The early onset recurrence rate of late onset epileptic seizures was high, and it was suggested that the electroencephalogram of epileptic patients after the first AEDs treatment after the first onset of.2. stroke generally did not involve the background abnormalities, mainly the slow wave accompanied by epileptic waves, and the slow wave reaction to a certain extent of the brain damage. The frequency of the seizures in patients with PSE was lower (by AEDs). 2 times / year, 1~2 AEDs can get better control and get a long time without seizure and AEDs dosage is small.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.1;R743.3

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