中青年卒中后癫痫的危险因素及首次抗癫痫药物选择的分析

Risk Factors for Post-Stroke Epilepsy in Young and Middle-Aged Adults and Analysis of First Antiepileptic Drug Selection

摘要: 目的：评估中青年患者脑卒中后癫痫发作的危险因素及首选抗癫痫药物情况。方法：回顾性收集青岛大学附属医院2018年1月~2019年12月中青年(年龄18~65岁)脑卒中患者的临床及影像学资料，将病人分为卒中后癫痫组和非卒中后癫痫组。计数资料采用卡方检验进行组间比较，计量资料采用t检验或非参数检验进行组间比较。采用二元Logistic分析卒中后癫痫的危险因素。结果：最终纳入1278例中青年急性缺血性卒中患者，其中早发性痫性发作发病率为1.4%，晚发性痫性发作即卒中后癫痫发病率3.8%。2组在NIHSS评分、房颤、恶性肿瘤、TOAST分型及住院期间应用抗生素药物、皮层受累、多脑叶受累、大脑中动脉供血区受累、出血转化及早发性痫性发作比较差异均具有统计学意义(P < 0.05)；多因素Logistic分析显示，NIHSS评分、住院期间应用抗生素药物、皮层受累及早发性痫性发作是中青年卒中后癫痫的独立危险因素(P < 0.05)。在癫痫发作类型方面，单纯部分性发作和全面性发作为卒中后癫痫的常见发作类型。在癫痫治疗方面，丙戊酸钠为最常用的AED药物，其次为左乙拉西坦。结论：在中青年卒中患者中，卒中严重程度(NIHSS评分)、住院期间应用抗生素药物、皮层受累及早发性痫性发作为卒中后癫痫的危险因素，可作为筛选高风险发病人群的依据并制定癫痫预防方案。

Abstract: Objective: To assess risk factors for post-stroke epilepsy in young and middle-aged adults and first antiepileptic drug selection. Method: The clinical and imaging materials of young and middle-aged AIS patients from the Affiliated Hospital of Qingdao University which were collected from January 2018 to December 2019 were analyzed retrospectively, and the patients were assigned into a post-stroke epilepsy group and a non-post-stroke epilepsy group. The chi-square test was used for comparison between groups for count data, and the t-test or non-parametric test was used for com-parison between groups for measurement data. Binary logistic regression was used to analyze the risk factors for post-stroke epilepsy. Results: A total of 1278 young and middle-aged AIS patients were enrolled. Among them, the incidence of early seizure after stroke was 1.4%, while 3.8% was late seizure (i.e., post-stroke epilepsy). Compared the two groups, the differences of NIHSS score, atrial fibrillation, cancer, TOAST, cortical involvement, two or more lobes were involved, the terri-tory of MCA, hemorrhagic transformation, and early seizure were statistically significant (P < 0.05). The multivariate logistic regression analysis showed that the factors independently associated with post-stroke epilepsy were NIHSS score, the use of antibiotics during the hospitalization, cortical in-volvement, and early seizure (P < 0.05). Simple partial seizures and generalized seizures were the most common type of post-stroke epilepsy. Sodium valproate was the most commonly used AED of the first choice, followed by levetiracetam. Conclusions: Stroke severity, the use of antibiotics during hospitalization, cortical involvement, and early seizure are the high risk factors for post-stroke epi-lepsy in young and middle-aged patients, which can be used as screening high-risk patients group basis and development of epilepsy prevention programs.