脑卒中后癫痫.ppt

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2024-08-19 发布于广东
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脑卒中后癫痫.ppt

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**癫痫发作也可引起脑血管疾病。**中风相关性癫痫也是神经外科经常遇到的癫痫发作类型。2009年的流行病学调查显示：脑缺血性疾病患者的癫痫发病风险是3%，脑出血是10%，蛛网膜下腔出血是9%。Nervenarzt.2009Mar28.Seizuresandepilepsiesafterstroke.[ArticleinGerman]HamerHM.NeurologischeUniversit?tsklinik,UKGMMarburg,Rudolf-Bultmann-Strasse8,35033,Marburg,Deutschland,hamer@med.uni-marburg.de.Epilepsiesafterstrokerepresent20%ofalladult-onsetepilepsiesandexhibitspecialcharacteristicswithrespecttodiagnosis,treatment,andprognosis.Patientsarefrequentlyamnesticfortheirseizuresthesignsofwhichcanbeverysubtle.Postictalparesesandconfusionalstatescanlastfordays,whichfurthercomplicatediagnosis.Singleseizuresafterstrokewerereportedin2%to10%ofcases,andcommunity-basedstudiesfoundepilepsiesin3%to4%ofstrokepatients.Analysesofsubgroupsidentifiedepilepsyrisksof3%afterischemicinfarction,6%to10%afterintracerebralhemorrhage,and9%aftersubarachnoidhemorrhage.Statusepilepticusdevelopedinlessthan1%ofstrokepatients.Besidesetiology,furtherriskfactorsforepilepsycomprise:remoteseizures(latency2weeks,riskofrecurrence50%)morethanearlyseizures(latency2weeks,riskofrecurrence50%),extentofstroke,corticalinvolvement,anddegreeofneurologicaldeficit.Thefirstappearanceofseizuresinpatientsolderthan60yearsrepresentsariskfactorforfuturestrokewithahazardratioof2.89.ThereiscurrentlynosufficientevidenceforstartingAEDtreatmentbeforeseizuresoccur.ThebenefitisstillunclearofstartingAEDafterasingleearlypost-strokeseizure.MostauthorsrecommendAEDtreatmentafterthesecondseizurebutalsoafterafirstremoteseizurebecauseofthehighriskofseizurerecurrenceinthesesituations.PossiblepharmacokineticinteractionsshouldbeconsideredwhenchoosingAED.Especiallythefirst-generationAEDcarrythepotentialtointeractwithcomedication,whichisusuallyseeninstrokepatientsreceivin