老年脑卒中后并发癫痫的影响因素、临床特征及预后

Influencing factors,clinical characteristics and prognosis of post-stroke epilepsy in elderly patients

中文关键词: 老年  脑卒中  癫痫  临床特征  预后

英文关键词: elderly  stroke  epilepsy  clinical characteristics  prognosis

中文摘要:

      目的 分析老年脑卒中后并发癫痫(PSE)的影响因素、临床特征及预后.方法 行回顾性研究,将南充市第五人民医院2021年3月-2023年3月收治的90例老年缺血性脑卒中后继发癫痫者纳为PSE组,同期收治的90例老年缺血性脑卒中但未发生癫痫患者作为对照组.收集并比较PSE组与对照组患者基本信息、既往史、卒中相关病情信息及神经功能缺损情况,以2组比较差异有统计学意义的因素为自变量,是否继发癫痫为因变量,采用Logistic回归模型分析影响老年缺血性脑卒中患者发生PSE的相关因素,并分析PSE患者癫痫类型、发病特点,以及PSE对患者神经功能恢复的影响.结果 PSE组病灶累及皮质、NIHSS ≥ 15分、颈动脉循环受累、梗死后出血转化占比均高于对照组,差异均有统计学意义(P＜0.05);Logistic多因素分析显示,病灶累及皮质(OR=1.533,95％CI 1.088～2.160)、颈动脉循环受累(OR=1.373,95％CI 1.081～1.744)、NIHSS 评分 ≥ 15 分(OR=1.499,95％CI 1.098～2.048)、出血转化(OR=1.292,95％CI 1.109～1.505)均为PSE的独立危险因素因素;早发型癫痫发作类型以局灶性发作(46.87％)为主,晚发型癫痫发作类型以局灶继发全面性发作(53.84％)为主;PSE组入院8 h、出院时及末次随访时NIHSS评分均高于对照组,差异均有统计学意义(P＜0.05).结论 病灶累及皮质、颈动脉循环受累、NIHSS评分≥15分及出血转化是老年脑卒中患者发生PSE的独立危险因素,早发型癫痫多表现为局灶性发作,晚发型癫痫多表现为局灶继发全面性发作,且PSE的发生可加重卒中患者的神经功能损害,影响神经功能恢复,临床应重视上述高危因素,早识别、早干预.

英文摘要:

      Objective To analyze the influencing factors,clinical characteristics and prognosis of post-stroke epilepsy(PSE)in elderly patients.Methods A retrospective study was conducted.90 elderly patients with secondary epilepsy after is-chemic stroke admitted to Fifth People's Hospital of Nanchong City from March 2021 to March 2023 were included in PSE group,and 90 elderly patients with ischemic stroke but without epilepsy admitted to this hospital during the same period were included in control group.The basic information,past history,stroke-related disease information and neurological deficits were collected and compared between the two groups.The factors with statistically significant differences between both groups were used as independent variables,and presence or absence of secondary epilepsy was taken as dependent variable.Logistic regres-sion model was used to analyze the related factors affecting the occurrence of PSE in elderly patients with ischemic stroke.The types and characteristics of epilepsy in PSE patients,as well as the effects of PSE on the recovery of neurological function were analyzed.Results The proportions of patients with lesions involvement of cortex,NIHSS score ≥ 15,carotid circulation in-volvement,and post-infarction hemorrhage transformation in the PSE group were higher than those in the control group,and the differences were statistically significant(P＜0.05).Logistic multivariate analysis showed that lesion involvement of cortex(OR=1.533,95％CI 1.088-2.160),carotid circulation involvement(OR=1.373,95％CI 1.081-1.744),NIHSS score≥15 points(OR=1.499,95％CI 1.098-2.048)and hemorrhage transformation(OR=1.292,95％CI 1.109-1.505)were in-dependent risk factors for PSE.The type of early-onset epilepsy seizures was mainly focal seizures(46.87％),and the type of late-onset epilepsy seizures was mainly focal secondary generalized seizures(53.84％).The NIHSS score of the PSE group was higher than that of the control group at 8 h after admission,at discharge and at the last follow-up,with statistical signifi-cance(P＜0.05).Conclusion Lesion involvement of cortex,carotid circulation involvement,NIHSS score≥15 points and hemorrhage transformation are independent risk factors for PSE in elderly stroke patients.Early-onset epilepsy is mostly mani-fested as focal seizures,and late-onset epilepsy is mostly manifested as focal secondary generalized seizures.The occurrence of PSE can aggravate the neurological impairment of stroke patients and affect the recovery of neurological function.It is necessary to pay attention to the above high risk factors for early identification and early intervention in clinical practice.