不同类型卒中后癫痫的发病特点

目的探讨不同类型卒中后癫痫的发病特点。方法回顾性收集2005年1月—2010年7月煤炭总医院神经内科就诊的卒中患者1322例的资料,其中115例发生卒中后癫痫,根据不同的卒中类型,分为脑梗死（CI）组79例、脑出血（CH）组26例,蛛网膜下腔出血（SAH）组10例。比较3组患者癫痫的发生时间、发生类型、异常脑电图、治疗结果的差异及脑梗死和脑出血发生的部位。结果①卒中后癫痫的发生率为8.7%（115/1322）,其中SAH组的癫痫发生率最高（16.1%）,CH组的发生率为11.5%,CI组最低（7.6%）,差异有统计学意义（χ2=7.911,P〈0.02）。②早发性癫痫的发生率（65.2%）高于迟发性癫痫（34.8%）,差异有统计学意义（U=3.260,P〈0.01）。卒中后癫痫发生的时间经Ridit分析,SAH后癫痫的发生最早,与CI组比较,差异有统计学意义。③3组患者卒中后癫痫的发生类型比较,差异有统计学意义（χ2=31.522,P〈0.01）。其中CI组患者以部分性发作为主,占58.2%（46/79）;CH组患者中部分性发作和全身性发作各占42.3%（11/26）;SAH组患者中80.0%为全身性发作,20.0%为癫痫持续状态。④卒中后癫痫患者的脑电图异常率高,达94.8%（109/115）,3组患者的脑电图异常发生率的比较,差异无统计学意义（χ2=0.847,P=0.655）。⑤经积极治疗后,103例患者的癫痫得到控制,12例患者死亡。SAH组患者的病死率最高（40.0%,4/10）;CI组最低（6.3%,5/79）,CH组的病死率为11.5%（3/26）,组间比较差异有统计学意义（χ2=11.071,P〈0.01）。结论 3种类型卒中患者中,SAH后癫痫的发生最早、发生率最高、病死率最高。经积极治疗卒中后癫痫患者的预后较好。

Clinical features in patients with poststroke epilepsy

Objective To investigate the clinical features of poststroke epilepsy and its related factors.Methods A total of 1322 patients with stroke diagnosed in the Department of Neurology,Coal General Hospital in Beijing from January 2005 to July 2010 were recruited,115 of them had poststroke epilepsy.They were divided into a cerebral infarction(CI) group(n=79),cerebral hemorrhage(CH) group(n=26),and subarachnoid hemorrhage(SAH) group(n=10) according to the different types of stroke.The time differences of epilepsy onset,the type of epilepsy,abnormality of electroencephalography(EEG),and the therapuetic outcomes in the patients of the 3 groups were compared.Results ①The incidence of epilepsy after stroke was 8.7%(115/1322),and the incidence of epilepsy was highest in the SAH group(16.1%),it was 11.5% in the CH group,and the lowest was the CI group(7.6%).there were significant differences(χ2=7.911,P<0.02).②The incidence of early-onset epilepsy(65.2%) was higher than that of late-onset epilepsy(34.8%),there was significant difference(U=3.260,P<0.01).The onset time of seizures after stroke after Ridit analysis: the SAH group was the earliest,and compared to the CI group there was significant difference.③There were significant differences as compared to the types of onset in patients with stroke among the 3 groups(χ2=31.522,P<0.01).The patients in the CI group were mainly partial seizures,accounting for 58.2%(46/79).In the CH group partial seizures and generalized seizures each accounted for 42.3%(11/26).In the patients of the SAH group,80.0% was generalized seizures and 20.0% was status epilepticus.④The abnormal rate of EEG in patients with epilepsy after stroke was as high as 94.8%(109/115).There were no significant differences in the abnormal rate of EEG among the 3 groups(χ2=0.847,P=0.655).⑤After aggressive treatment,the epilepsy in 103 patients was controlled and 12 patients died.The mortality was highest in patients of the SAH group(40.0%,4/10);it was lowest in patients of the CI group(6.3%,5/79),and the mortality was 11.5%(3/26) in the CH group.There were significant differences among the 3 groups(χ2=11.071,P<0.01).Conclusion Poststroke epilepsy was associated with different types of cerebrovascular disease,the site of lesion,and the course of disease.After active treatment,the prognosis of the patients with poststroke epilepsy is good.