外伤性癫痫的诊断分类及流行病学特点

目的探讨颅脑损伤后继发性癫痫的诊断分类及流行病学特点。 方法回顾性分析1 799例颅脑损伤患者的临床资料，重点分析颅脑损伤轻重程度及损伤部位与外伤性癫痫发病特点的相关性，不同类型颅脑损伤在发作时间上的差异，结合临床资料，分析外伤性癫痫发病的诊断类型及流行病学特点。PTE发病率的显著性比较采用卡方检验。 结果颅脑损伤超早期癫痫发生率高达29.8%，1周、1个月及3个月后分别下降至12.4%、6.7%、5.2%，重型颅脑损伤(格拉斯哥昏迷评分3～8分)癫痫发生率为19.5%，明显高于轻中型颅脑损伤(格拉斯哥昏迷评分9～12分、13～15分)患者。穿通伤、手术及非手术患者癫痫发生率分别为36%、15.9%和2.5%，开放性颅脑损伤癫痫发生率为26.5%，未成年组及成年组外伤性癫痫发生率分别为14.1%、3.5%，癫痫发病患者脑损伤大多位于功能区，如额后叶、顶叶、枕叶及弥漫性脑皮层损伤。 结论颅脑损伤的超早期、早期、晚期，外伤性癫痫的发病率有显著差异；重型颅脑损伤后癫痫发生率明显高于轻中型；穿通及开放性发生率明显高于闭合性颅脑损伤，年龄越小发生癫痫概率越高，功能区脑损伤癫痫发生率明显高于非功能区。

Diagnostic classification and epidemiology of post-traumatic epilepsy

ObjectiveTo investigate the diagnostic classification and epidemiological characteristics of secondary epilepsy post-craniocerebral trauma. MethodsThe clinical data of one thousand seven hundred and ninty-nine patients with craniocerebral injury were retrospectively analyzed.The correlation of craniocerebral injury severity to characteristics of injury and traumatic epilepsy, the differences of onset time of different types of craniocerebral injury were analyzed.The diagnostic classification and epidemiological characteristics of traumatic epilepsy were also analyzed in combination with clinical data. ResultsThe rate of super early epilepsy craniocerebral injury rate was as high as 29.8%.After a week, a month or three months, it fell to 12.4%, 6.7% and 5.2% respectively.The incidence of severe head injury(GCS: 3~8 points) epilepsy was 19.5%, which was significantly higher than that of light or moderate duty craniocerebral injury(GCS: 9~12, 13~15 points) patients.The rates of penetrating wound surgery and non-surgical patients with epilepsy were 36.0%, 15.9% and 2.5% respectively.The rate of open craniocerebral injury incidence of epilepsy was 26.5% and the rates of the impuberism groups and the adult group traumatic epilepsy were 14.1%, 3.5% respectively.The brain injury of epilepsy patients mainly located in the brain functional areas such as the frontal lobe and parietal and occipital lobe after diffuse brain cortex injury. ConclusionsThere are obvious differences in the incidence of traumatic epilepsy during super early, early and late period of craniocerebral injury.The incidence of severe head injury is significantly higher than that of the light and the middle.The rates of penetrating injury and the open injury are obviously higher than those of the closed craniocerebral injury.The impuberism has higher epilepsy risk rate.The rate of functional areas of brain injury epilepsy is significantly higher than that of the non-functional.